Healthcare Provider Details

I. General information

NPI: 1205238805
Provider Name (Legal Business Name): ALISON STULL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON MCGEE

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

847 NE 19TH AVE SUITE 300
PORTLAND OR
97232-2684
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7374
  • Fax: 360-514-7384
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61131763
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA170090
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.200731
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: