Provider Demographics
NPI:1063647923
Name:PETERS, PAMELA LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:90 SE KLAH CHE MIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9216
Mailing Address - Country:US
Mailing Address - Phone:360-427-9006
Mailing Address - Fax:360-427-1951
Practice Address - Street 1:90 SE KLAH CHE MIN DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9216
Practice Address - Country:US
Practice Address - Phone:360-427-9006
Practice Address - Fax:360-427-1951
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00061427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1254ROOtherREGENCE BLUESHIELD