1093089591 NPI number — DONALD P ZIETZ AAS-HIS

Table of content: DONALD P ZIETZ AAS-HIS (NPI 1093089591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093089591 NPI number — DONALD P ZIETZ AAS-HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIETZ
Provider First Name:
DONALD
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AAS-HIS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093089591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22525 SE 64TH PL
Provider Second Line Business Mailing Address:
STE 2030
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-5383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-358-0956
Provider Business Mailing Address Fax Number:
877-481-6931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 E COLLEGE WAY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98273-2362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-336-5881
Provider Business Practice Location Address Fax Number:
360-336-2323
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA00004650 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 332500000X , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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