Basic Information
| Provider Information | |||||||||
| NPI: | 1700890928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTMAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP,PHN,RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 2ND AVE S | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554023318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126597111 | ||||||||
| FaxNumber: | 6126597101 | ||||||||
| Practice Location | |||||||||
| Address1: | 9057 MARY AVE NW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981173428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052768017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP30007897 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 110039977 | 01 | CA | MEDICARE RAILROAD | OTHER | ZZZ75566Z | 05 | CA | MEDICAID | ZZZ34679Z | 01 | CA | BLUE CROSS | OTHER | 525438 | 05 | CA | MEDICAID |