Provider Demographics
NPI:1861692170
Name:CHARBONEAU, PAMELA SUE (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:CHARBONEAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-383-3325
Mailing Address - Fax:253-572-7875
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:STE 204
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-383-3325
Practice Address - Fax:253-572-7875
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3007734363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0289066OtherSTATE L&I
WA0289066OtherSTATE L&I