Basic Information
| Provider Information | |||||||||
| NPI: | 1215369749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IAMS | ||||||||
| FirstName: | RAE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOWE | ||||||||
| OtherFirstName: | RAE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3209 S 23RD ST | ||||||||
| Address2: | STE 340 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533838342 | ||||||||
| FaxNumber: | 2535728204 | ||||||||
| Practice Location | |||||||||
| Address1: | 11216 SUNRISE BLVD E | ||||||||
| Address2: | STE 3-207 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983748848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537703700 | ||||||||
| FaxNumber: | 2534357019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2013 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP 60403597 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP60403597 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | AP60403597 | 01 | WA | WA LICENSE ARNP | OTHER | G001045700 | 01 | WA | GROUP PTAN(P) | OTHER | G000188100 | 01 | WA | GROUP PTAN(K) | OTHER | 2033476 | 05 | WA | MEDICAID |