Provider Demographics
NPI:1396888715
Name:PUTMAN, ANN MARGARET (PAC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARGARET
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:MARGARET
Other - Last Name:KOEHLER PUTMAN & COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:518 E CLAY AVE
Mailing Address - Street 2:PO BOX 198
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-8947
Mailing Address - Country:US
Mailing Address - Phone:509-935-8424
Mailing Address - Fax:509-935-8402
Practice Address - Street 1:518 E CLAY AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8947
Practice Address - Country:US
Practice Address - Phone:509-935-8424
Practice Address - Fax:509-935-8402
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004381363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194431OtherLABOR & INDUSTRIES ID #
WA8416125Medicaid
WA8851202Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8851204Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8851201Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8851206Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8851205Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8416125Medicaid
WA8851203Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER