Healthcare Provider Details

I. General information

NPI: 1790534469
Provider Name (Legal Business Name): ANDREA ZINNECKER-MACKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 W 6TH AVE
AIRWAY HEIGHTS WA
99001-5345
US

IV. Provider business mailing address

10811 W 6TH AVE
AIRWAY HEIGHTS WA
99001-5345
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-4990
  • Fax: 206-703-2564
Mailing address:
  • Phone: 509-481-4990
  • Fax: 206-703-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN61456683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: