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NPI Code Detail

MEDICARE: MS. PAMELA KAY VANDENBERG L.M.P.

MEDICARE: MS. PAMELA KAY VANDENBERG L.M.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0014358WA

General Provider Information

NPI Number : 1386713287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA KAY VANDENBERG L.M.P.
Provider Business Mailing Address
First Line : 6212 75TH ST W
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-8368
Country : US
Telephone Number : 253-222-6568
Fax Number : 253-272-4760
Provider Business Practice Location Address
First Line : 6212 75TH ST W
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-8368
Country : US
Telephone Number : 253-222-6568
Fax Number : 253-272-4760
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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