Provider Demographics
NPI:1659089621
Name:LOGALBO, PAMELA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:LOGALBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 S MARKET BLVD # 10086
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3826
Mailing Address - Country:US
Mailing Address - Phone:360-324-8156
Mailing Address - Fax:
Practice Address - Street 1:218 MAIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356-9853
Practice Address - Country:US
Practice Address - Phone:360-324-8156
Practice Address - Fax:360-983-3032
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00156956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse