Provider Demographics
NPI:1871653915
Name:COURT, PAMELA R (CRNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:COURT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19205 N CONCHO CIR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-1406
Mailing Address - Country:US
Mailing Address - Phone:509-998-7697
Mailing Address - Fax:
Practice Address - Street 1:19205 N CONCHO CIR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1406
Practice Address - Country:US
Practice Address - Phone:509-998-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30007682367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00416784OtherRR MEDICARE ID
WA9652710Medicaid
WAG000362000OtherMEDICARE GROUP
WA9652710Medicaid
TXP00246806Medicare ID - Type UnspecifiedRR MEDICARE ID
WAP00416784OtherRR MEDICARE ID