Provider Demographics
NPI:1558628891
Name:ALLIED PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:ALLIED PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-894-4702
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1960
Mailing Address - Country:US
Mailing Address - Phone:360-894-4702
Mailing Address - Fax:
Practice Address - Street 1:10501 CREEK ST SE STE 2
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9805
Practice Address - Country:US
Practice Address - Phone:360-894-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty