MEDICARE: PAMELA CUNNINGHAM

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
1	163W00000X	Registered Nurse	RN00124087	WA

General Provider Information

NPI Number	:	1124360409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA CUNNINGHAM

Provider Business Mailing Address
First Line	:	706 S ENNIS ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-6648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 S ENNIS ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-6648
Country	:	US
Telephone Number	:	360-457-6018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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Directions to “ PAMELA CUNNINGHAM ” Practice Location

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