Healthcare Provider Details

I. General information

NPI: 1245118132
Provider Name (Legal Business Name): ZACHARY IRELAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DIVISION ST
AUBURN WA
98001-4939
US

IV. Provider business mailing address

6507 1/2 4TH AVE NW
SEATTLE WA
98117-5007
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7711
  • Fax:
Mailing address:
  • Phone: 970-412-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.PA.70025946
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberPA.PA.70025946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: