Basic Information
| Provider Information | |||||||||
| NPI: | 1689814337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOTSON | ||||||||
| FirstName: | MACHELLE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1519 | ||||||||
| Address2: | |||||||||
| City: | WHITE SALMON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986721519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094932133 | ||||||||
| FaxNumber: | 5094939538 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 SW ROCK CREEK DR | ||||||||
| Address2: | |||||||||
| City: | STEVENSON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986484404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094274212 | ||||||||
| FaxNumber: | 5094274955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2009 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA01434 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA60095040 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 7065576 | 05 | WA | MEDICAID | 765113 | 05 | WA | MEDICAID | 7033376 | 05 | WA | MEDICAID |