Healthcare Provider Details

I. General information

NPI: 1912094384
Provider Name (Legal Business Name): PAMELA MARY MAJERLE M.P.H. R.D. C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 179TH AVE SE
MONROE WA
98272-1108
US

IV. Provider business mailing address

PO BOX 21 26910 NE KENNEDY DR.
DUVALL WA
98019-0021
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-1447
  • Fax:
Mailing address:
  • Phone: 206-300-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001325
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: