Basic Information
Provider Information
NPI: 1437784618
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AYSON
FirstName: PAMELA
MiddleName: ROSE
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 50095
Address2:  
City: SEATTLE
State: WA
PostalCode: 981455095
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1959 NE PACIFIC ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981950001
CountryCode: US
TelephoneNumber: 2065205000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/07/2020
LastUpdateDate: 05/06/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN60421883WAN Nursing Service ProvidersRegistered Nurse 
363LA2100XAP61297821WAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363L00000XAP61297821WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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