Pamela J Korzeniowski, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10004708 Issued in WA

Practice address

2373 Old Tokeland Rd
Tokeland, WA 98590

Phone

(360) 267-0119

Fax

(360) 267-0417

NPI assigned

May 4, 2007

Last updated

Jan 24, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1689886475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "985900500",
            "telephone_number": "360-267-0119",
            "fax_number": "360-267-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 OLD TOKELAND RD",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "98590",
            "telephone_number": "360-267-0119",
            "fax_number": "360-267-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORZENIOWSKI",
        "first_name": "PAMELA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8426595",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Dale Cebulla, DDS
• Pawel Michal Dutkiewicz, M.D.
• Joseph Goodfellow, LMHC-A
• Laura A Hamilton, CHEMICAL DEPENDENCY
• Jeanne Paul, LMFT
• F. Scott Powell, D.C.
• Sherwin Rex Shinn, DDS
• Shoalwater Bay Indian Tribe (Shoalwater Bay Tribal Clinic)
• Shoalwater Bay Indian Tribe (Shoalwater Bay Tribal Clinic)

• Medical Physician Assistant in Tokeland, WA
• Providers in Tokeland, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.