Provider Demographics
NPI:1881767689
Name:CORRALL, PAMELA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:CORRALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 NO PEARL
Mailing Address - Street 2:STE 405
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-752-8833
Mailing Address - Fax:253-752-5400
Practice Address - Street 1:2102 NO PEARL
Practice Address - Street 2:STE 405
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-752-8833
Practice Address - Fax:253-752-5400
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149305163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8864625Medicare PIN
WAQ77619Medicare UPIN