Provider Demographics
NPI:1689814337
Name:DOTSON, MACHELLE M (PA)
Entity Type:Individual
Prefix:MS
First Name:MACHELLE
Middle Name:M
Last Name:DOTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1519
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-1519
Mailing Address - Country:US
Mailing Address - Phone:509-493-2133
Mailing Address - Fax:509-493-9538
Practice Address - Street 1:875 SW ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4404
Practice Address - Country:US
Practice Address - Phone:509-427-4212
Practice Address - Fax:509-427-4955
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01434363AM0700X
WAPA60095040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7065576Medicaid
WA765113Medicaid
WA7033376Medicaid
WA000680900Medicare PIN
WA765113Medicaid