Provider Demographics
NPI:1699981084
Name:CHAMPAGNE-L'ESPERANCE, PAMELA JO (LMP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JO
Last Name:CHAMPAGNE-L'ESPERANCE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 180TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4502
Mailing Address - Country:US
Mailing Address - Phone:206-618-0044
Mailing Address - Fax:206-542-9683
Practice Address - Street 1:1331 N 180TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4502
Practice Address - Country:US
Practice Address - Phone:206-618-0044
Practice Address - Fax:206-542-9683
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA000013441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist