Provider Demographics
NPI:1548592546
Name:HUBBARD, ZENDA RANAE (LMP)
Entity Type:Individual
Prefix:MS
First Name:ZENDA
Middle Name:RANAE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:ZENDA
Other - Middle Name:RANAE
Other - Last Name:REIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COULEE CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99115
Mailing Address - Country:US
Mailing Address - Phone:509-632-8668
Mailing Address - Fax:509-632-5761
Practice Address - Street 1:130 N ADAMS ST.
Practice Address - Street 2:
Practice Address - City:COULEE CITY
Practice Address - State:WA
Practice Address - Zip Code:99115
Practice Address - Country:US
Practice Address - Phone:509-632-8668
Practice Address - Fax:509-632-5761
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60115273225700000X
WACX602387502471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACX60238750OtherSTATE OF WASHINGTON