Provider Demographics
NPI:1326297714
Name:KEAN, PAMELA ANNE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:KEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 NE 165TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5422
Mailing Address - Country:US
Mailing Address - Phone:617-943-1467
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST BOX 356540
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-5422
Practice Address - Country:US
Practice Address - Phone:617-943-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60030589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered