Healthcare Provider Details

I. General information

NPI: 1154297760
Provider Name (Legal Business Name): ZAK THATCHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22522 29TH DR SE # L210
BOTHELL WA
98021-4443
US

IV. Provider business mailing address

22522 29TH DR SE # L210
BOTHELL WA
98021-4443
US

V. Phone/Fax

Practice location:
  • Phone: 509-774-7874
  • Fax:
Mailing address:
  • Phone: 509-774-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61649878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: