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JOHN RUSSELL PRENTICE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
11808 NE FOURTH PLAIN RD, SUITE A, VANCOUVER, WA 98682-5524
(360) 253-6947
(360) 256-9547
Mailing address
11808 NE FOURTH PLAIN RD, SUITE A, VANCOUVER, WA 98682-5524
(360) 253-6947
(360) 256-9547

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002522
WV

Other

Enumeration date
11/09/2005
Last updated
07/08/2007
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