Healthcare Provider Details

I. General information

NPI: 1548592546
Provider Name (Legal Business Name): ZENDA RANAE HUBBARD LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZENDA RANAE REIDT LMP

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N ADAMS ST.
COULEE CITY WA
99115
US

IV. Provider business mailing address

PO BOX 817
COULEE CITY WA
99115
US

V. Phone/Fax

Practice location:
  • Phone: 509-632-8668
  • Fax: 509-632-5761
Mailing address:
  • Phone: 509-632-8668
  • Fax: 509-632-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60115273
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCX60238750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: