Provider Demographics
NPI:1215369749
Name:IAMS, RAE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:ANN
Last Name:IAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:ANN
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST
Mailing Address - Street 2:STE 340
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:253-383-8342
Mailing Address - Fax:253-572-8204
Practice Address - Street 1:11216 SUNRISE BLVD E
Practice Address - Street 2:STE 3-207
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-770-3700
Practice Address - Fax:253-435-7019
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60403597363LF0000X
WAAP60403597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60403597OtherWA LICENSE ARNP
WAG001045700OtherGROUP PTAN(P)
WAG000188100OtherGROUP PTAN(K)
WA2033476Medicaid
WAAP60403597OtherWA LICENSE ARNP
WA2033476Medicaid