Basic Information
| Provider Information | |||||||||
| NPI: | 1134177850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINGEL | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | SHERYL | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 S 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095754084 | ||||||||
| FaxNumber: | 5092256313 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 S 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095754084 | ||||||||
| FaxNumber: | 5092256313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
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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 | 363LP0808X | AP30004066 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1134177850 | 05 | WA | MEDICAID |