Healthcare Provider Details

I. General information

NPI: 1003080060
Provider Name (Legal Business Name): MARY ANN ZENGER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 08/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

IV. Provider business mailing address

58 CEDAR AVE
SNOHOMISH WA
98290-2929
US

V. Phone/Fax

Practice location:
  • Phone: 425-337-9556
  • Fax:
Mailing address:
  • Phone: 360-563-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00004732
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: