Provider Demographics
NPI:1205863982
Name:GOLLIET, PAMELA (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:GOLLIET
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 SW 332ND PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2922
Mailing Address - Country:US
Mailing Address - Phone:253-835-7400
Mailing Address - Fax:253-874-1912
Practice Address - Street 1:3756 SW 332ND PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2922
Practice Address - Country:US
Practice Address - Phone:253-835-7400
Practice Address - Fax:253-874-1912
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000296176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMW00000296OtherLICENSED MIDWIFE
WA7127913Medicaid