Provider Demographics
NPI:1881761500
Name:ZYLSTRA, SHARON LOUISE (LMP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LOUISE
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:LOUISE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:17066 BEATON RD SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1002
Mailing Address - Country:US
Mailing Address - Phone:360-863-0960
Mailing Address - Fax:360-863-8710
Practice Address - Street 1:17066 BEATON RD SE
Practice Address - Street 2:SUITE 170
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1002
Practice Address - Country:US
Practice Address - Phone:360-863-0960
Practice Address - Fax:360-863-8710
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist