=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609153766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUTTON VETERINARY MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2011
-----------------------------------------------------
Last Update Date | 11/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 EAST LAKE STREET
-----------------------------------------------------
City | MEDICAL LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-299-3675
-----------------------------------------------------
Fax | 509-299-3279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 156 212 EAST LAKE STREET
-----------------------------------------------------
City | MEDICAL LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99022-0156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-299-3675
-----------------------------------------------------
Fax | 509-299-3279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VETERINARIAN/OWNER
-----------------------------------------------------
Name | DR. TRINA ROSE DUTTON
-----------------------------------------------------
Credential | DVM
-----------------------------------------------------
Telephone | 509-299-3675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number | VT60108256
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------