Healthcare Provider Details

I. General information

NPI: 1720781883
Provider Name (Legal Business Name): ALLISON THERESE ZAJAKALA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

IV. Provider business mailing address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

V. Phone/Fax

Practice location:
  • Phone: 208-457-4211
  • Fax: 208-773-1473
Mailing address:
  • Phone: 208-457-4211
  • Fax: 208-773-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2567
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: