Provider Demographics
NPI:1053452870
Name:ZUKOWSKI-WEST, CARLA ANITA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANITA
Last Name:ZUKOWSKI-WEST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:ANIT
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16209 SE 251ST ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4152
Mailing Address - Country:US
Mailing Address - Phone:206-406-0203
Mailing Address - Fax:
Practice Address - Street 1:17224 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4953
Practice Address - Country:US
Practice Address - Phone:253-639-8540
Practice Address - Fax:253-639-8542
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020714247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other