Healthcare Provider Details

I. General information

NPI: 1972516532
Provider Name (Legal Business Name): PAMELA PETERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR SUITE 200
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

945 GOETHALS DR SUITE 200
RICHLAND WA
99352-3552
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-0300
  • Fax: 509-946-0707
Mailing address:
  • Phone: 509-943-0300
  • Fax: 509-946-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN00047360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: