Provider Demographics
NPI:1467538215
Name:ZELLNER, PAULA L (PAC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:ZELLNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:253-272-5127
Mailing Address - Fax:253-272-0811
Practice Address - Street 1:1703 S MERIDIAN STE 305
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7590
Practice Address - Country:US
Practice Address - Phone:253-841-3933
Practice Address - Fax:253-848-7970
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60184603363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01425765OtherRR MEDICARE
WA0272067OtherL&I AND CRIME VICTIMS
WAV998OtherTRI-WEST (TRICARE)
WA1467538215Medicaid
WAP01425765OtherRR MEDICARE
WAG8896706Medicare UPIN
COP76181Medicare UPIN
WA0272067OtherL&I AND CRIME VICTIMS
WAV998OtherTRI-WEST (TRICARE)