Provider Demographics
NPI:1932418431
Name:PRPICH, PAMELA DAWN (LMP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:PRPICH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98858-0767
Mailing Address - Country:US
Mailing Address - Phone:509-745-9302
Mailing Address - Fax:
Practice Address - Street 1:550 ROAD J NW
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:WA
Practice Address - Zip Code:98858-9741
Practice Address - Country:US
Practice Address - Phone:509-745-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
WAMA60163678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0267682OtherL & I AND PIP