Provider Demographics
NPI:1134177850
Name:PINGEL, CAROLYN SHERYL (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SHERYL
Last Name:PINGEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3546
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:509-225-6313
Practice Address - Street 1:402 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3546
Practice Address - Country:US
Practice Address - Phone:509-575-4084
Practice Address - Fax:509-225-6313
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1134177850Medicaid
WAAB27269Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA1134177850Medicaid
WAPO3411Medicare UPIN