Provider Demographics
NPI:1700890928
Name:ALTMAN, PAMELA (NP,PHN,RN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:NP,PHN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 2ND AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-3318
Mailing Address - Country:US
Mailing Address - Phone:612-659-7111
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:9057 MARY AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3428
Practice Address - Country:US
Practice Address - Phone:805-276-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007897363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110039977OtherMEDICARE RAILROAD
CAZZZ75566ZMedicaid
CAZZZ34679ZOtherBLUE CROSS
CA525438Medicaid
CA110039977OtherMEDICARE RAILROAD