Healthcare Provider Details

I. General information

NPI: 1588470546
Provider Name (Legal Business Name): ZACHARY MICHAEL OUSLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

IV. Provider business mailing address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

V. Phone/Fax

Practice location:
  • Phone: 425-789-3789
  • Fax:
Mailing address:
  • Phone: 425-789-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61640081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: