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General NPI Number Information
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NPI Number | 1417184870
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Entity Type | Individual
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Provider Name | PAMELA ELIZABETH WIREMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 629 AVENUE D
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City | SNOHOMISH
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State | WA
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Zip | 98290-2330
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Country | US
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Telephone | 360-568-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 12119 BOLLENBAUGH HILL ROAD
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City | MONROE
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State | WA
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Zip | 98272
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Country | US
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Telephone | 419-778-0614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 852
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60777975
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License Number State | WA
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