Provider Demographics
NPI:1356407084
Name:RADEMAKER, PAMELA L (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LASH O'NEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:550 17TH AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5788
Mailing Address - Country:US
Mailing Address - Phone:206-320-2800
Mailing Address - Fax:
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:STE 500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-320-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207594OtherLABOR AND INDUSTRIES
P23836Medicare UPIN
WA8859457Medicare ID - Type Unspecified