MEDICARE: PAMELA ANN WALCK ARNP

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	363LF0000X	Family Nurse Practitioner	AP30007857	WA

General Provider Information

NPI Number	:	1699961722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANN WALCK ARNP

Provider Business Mailing Address
First Line	:	3214 50TH STREET CT NW
Second Line	:	#204
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-851-1560
Fax Number	:	253-851-1580

Provider Business Practice Location Address
First Line	:	3214 50TH STREET CT NW
Second Line	:	#204
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-851-1560
Fax Number	:	253-851-1580

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

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	03/18/2015

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