Provider Demographics
NPI:1700192150
Name:STOCKHO, PAMALLA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:PAMALLA
Middle Name:ANN
Last Name:STOCKHO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAMALLA
Other - Middle Name:
Other - Last Name:MANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 100TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2752
Mailing Address - Country:US
Mailing Address - Phone:253-584-2119
Mailing Address - Fax:
Practice Address - Street 1:5700 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2752
Practice Address - Country:US
Practice Address - Phone:253-584-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60270264363L00000X, 363LC1500X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1063682375OtherMEDICARE NPI