Provider Demographics
NPI:1841748043
Name:DULAK, BRENTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRENTON
Middle Name:
Last Name:DULAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 PACIFIC AVE APT 812
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3128
Mailing Address - Country:US
Mailing Address - Phone:253-666-5125
Mailing Address - Fax:
Practice Address - Street 1:215 WHITESELL ST NW STE B113
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9363
Practice Address - Country:US
Practice Address - Phone:253-697-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant