Provider Demographics
NPI:1699961722
Name:WALCK, PAMELA ANN (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:WALCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3214 50TH STREET CT NW
Mailing Address - Street 2:#204
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8589
Mailing Address - Country:US
Mailing Address - Phone:253-851-1560
Mailing Address - Fax:253-851-1580
Practice Address - Street 1:3214 50TH STREET CT NW
Practice Address - Street 2:#204
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8589
Practice Address - Country:US
Practice Address - Phone:253-851-1560
Practice Address - Fax:253-851-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily