Provider Demographics
NPI:1497991053
Name:ZAHALKA, JEAN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:ZAHALKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 220TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6807
Mailing Address - Country:US
Mailing Address - Phone:360-654-1350
Mailing Address - Fax:
Practice Address - Street 1:3020 RUCKER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3900
Practice Address - Country:US
Practice Address - Phone:425-339-8717
Practice Address - Fax:425-339-8706
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00051798163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice