Provider Demographics
NPI:1134616477
Name:CELLUTIONS VANCOUVER, PLLC
Entity type:Organization
Organization Name:CELLUTIONS VANCOUVER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-464-1492
Mailing Address - Street 1:2621 NE 134TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3036
Mailing Address - Country:US
Mailing Address - Phone:800-280-0797
Mailing Address - Fax:360-450-4084
Practice Address - Street 1:2621 NE 134TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:800-280-0797
Practice Address - Fax:360-450-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60790564363L00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578954657OtherNPI