Provider Demographics
NPI:1861634313
Name:ZAHNISER, KELLY RITA (LMP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RITA
Last Name:ZAHNISER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 NE 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6938
Mailing Address - Country:US
Mailing Address - Phone:360-635-7574
Mailing Address - Fax:
Practice Address - Street 1:616 NE 81ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8136
Practice Address - Country:US
Practice Address - Phone:360-635-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist