Provider Demographics
NPI:1851323307
Name:ZINSLEY, MARYELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:ZINSLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:17000 140TH AVE NE
Practice Address - Street 2:SUITE # 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6928
Practice Address - Country:US
Practice Address - Phone:425-488-2273
Practice Address - Fax:425-488-4971
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006022363LA2200X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9640020Medicaid
WA0157902OtherL&I PIN
WA08654UOtherREGENCE BLUE SHIELD PIN
WA9640020Medicaid
WAG8878757Medicare PIN
WAG8897742Medicare PIN
WAAB27791Medicare PIN
WA08654UOtherREGENCE BLUE SHIELD PIN
P54954Medicare UPIN
WAG8883179Medicare PIN