Provider Demographics
NPI:1407901200
Name:DOSA, MICHELLE DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:DOSA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N PEARL ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2530
Mailing Address - Country:US
Mailing Address - Phone:253-752-8833
Mailing Address - Fax:253-752-5400
Practice Address - Street 1:2102 N PEARL ST
Practice Address - Street 2:SUITE 405
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2530
Practice Address - Country:US
Practice Address - Phone:253-752-8833
Practice Address - Fax:253-752-5400
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004710363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB29725Medicare PIN
WAS65850Medicare UPIN