Provider Demographics
NPI:1841597754
Name:CONNER, PAMELA ALEXANDRIA
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ALEXANDRIA
Last Name:CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11106 10TH AVENUE CT E
Mailing Address - Street 2:APT. C-107
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-7090
Mailing Address - Country:US
Mailing Address - Phone:253-495-0580
Mailing Address - Fax:
Practice Address - Street 1:10909 PORTLAND AVE E
Practice Address - Street 2:SUITE F
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-5252
Practice Address - Country:US
Practice Address - Phone:253-970-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00023814172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker