Healthcare Provider Details

I. General information

NPI: 1144703984
Provider Name (Legal Business Name): ALISON JOY PETTINGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S MERIDIAN STE 101
PUYALLUP WA
98371
US

IV. Provider business mailing address

6512 407TH ST E
EATONVILLE WA
98328-9277
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-3000
  • Fax:
Mailing address:
  • Phone: 253-355-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number61003696
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: