Provider Demographics
NPI:1972380236
Name:PAKOOTAS, MIA LYNN (MA-P,MA-R)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:LYNN
Last Name:PAKOOTAS
Suffix:
Gender:F
Credentials:MA-P,MA-R
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:LYNN
Other - Last Name:PAKOOTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-0290
Mailing Address - Country:US
Mailing Address - Phone:509-722-7006
Mailing Address - Fax:
Practice Address - Street 1:39 SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138
Practice Address - Country:US
Practice Address - Phone:509-722-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61401184246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory