Provider Demographics
NPI:1497825673
Name:PACEM, COLLEEN MULVIHILL (ARNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MULVIHILL
Last Name:PACEM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:D
Other - Last Name:MULVIHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:22850 NE 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7256
Practice Address - Country:US
Practice Address - Phone:425-898-0305
Practice Address - Fax:425-898-8825
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00160922163W00000X
WAAP30007552363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653809Medicaid
WAG8884530Medicare PIN
WAG8884529Medicare PIN
WAG8884531Medicare PIN
WAG8884528Medicare PIN
WAG8884536Medicare PIN
WAG8884532Medicare PIN
WAG8884533Medicare PIN
WAG8897694Medicare PIN
WAG8884534Medicare PIN
WAG8884535Medicare PIN