Provider Demographics
NPI:1538705322
Name:MARTIN, PAMELA ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:YUHNKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:503-201-3458
Mailing Address - Fax:
Practice Address - Street 1:300 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-2304
Practice Address - Country:US
Practice Address - Phone:360-353-5511
Practice Address - Fax:360-353-5502
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00148859163W00000X
WAAP61341041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse