Provider Demographics
NPI:1164948170
Name:ZELA, PENELOPE JUPITER (LM, CPM)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:JUPITER
Last Name:ZELA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10445 NE 113TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4322
Mailing Address - Country:US
Mailing Address - Phone:310-483-1351
Mailing Address - Fax:
Practice Address - Street 1:10445 NE 113TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4322
Practice Address - Country:US
Practice Address - Phone:310-483-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CALM504176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula