Healthcare Provider Details

I. General information

NPI: 1548214042
Provider Name (Legal Business Name): BECKY L ZUFALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE SUITE 310
EVERETT WA
98201-1684
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4925
  • Fax: 425-261-4932
Mailing address:
  • Phone: 866-366-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004524
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: