Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60270264 | WA |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP60270264 | WA |
N | 363LC1500X | Nurse Practitioner - Community Health | AP60270264 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60270264 | WA |
NPI | 1700192150 |
---|---|
Provider Name | Pamalla Ann Stockho |
First Address | Lakewood, WA 98499-2752 |
Second Address | Lakewood, WA 98499-2752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 24/01/2014 |