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General NPI Number Information
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NPI Number | 1699102871
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Entity Type | Individual
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Provider Name | TAMARA ANN COULTER DOTSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2434
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Country | US
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Telephone | 208-743-7612
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Fax | 208-746-4802
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | WAUNA
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State | WA
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Zip | 98395-0008
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Country | US
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Telephone | 360-731-2533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7686
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.60417452
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License Number State | WA
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