Provider Demographics
NPI:1558098640
Name:YOUNGMAN, PAMALA A (AAS)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:A
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1618
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1618
Mailing Address - Country:US
Mailing Address - Phone:406-702-6554
Mailing Address - Fax:
Practice Address - Street 1:603 1/2 COURT AVENUE
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-5925
Practice Address - Country:US
Practice Address - Phone:406-768-3852
Practice Address - Fax:406-768-5202
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-50310390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program