Provider Demographics
NPI:1205238805
Name:STULL, ALISON (PAC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:STULL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:505 NE 87TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-7374
Practice Address - Fax:360-514-7384
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA170090363AS0400X
LAPA.200731363AS0400X
WAPA61131763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040038Medicaid
OR500677537Medicaid
WA2040038Medicaid