Provider Demographics
NPI:1699011700
Name:ZIKE, TERRY LEANNA (LPN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEANNA
Last Name:ZIKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9552
Mailing Address - Country:US
Mailing Address - Phone:509-823-8911
Mailing Address - Fax:
Practice Address - Street 1:12815 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9552
Practice Address - Country:US
Practice Address - Phone:509-823-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00057570164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse