Provider Demographics
NPI:1851518625
Name:DUNNIWAY, MICHAEL R (PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:DUNNIWAY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E CLAY AVE
Mailing Address - Street 2:PO BOX 198
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-8947
Mailing Address - Country:US
Mailing Address - Phone:509-935-8424
Mailing Address - Fax:509-935-8402
Practice Address - Street 1:518 E CLAY AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8947
Practice Address - Country:US
Practice Address - Phone:509-935-8424
Practice Address - Fax:509-935-8402
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA127374OtherLABOR & INDUSTRIES ID #
WA8400855Medicaid
WA8400855Medicaid