Healthcare Provider Details

I. General information

NPI: 1700425881
Provider Name (Legal Business Name): ROKSOLANA ZAPOTICHNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7224 PACIFIC HWY E.
MILTON WA
98354
US

IV. Provider business mailing address

17834 120TH AVE SE
RENTON WA
98058-6648
US

V. Phone/Fax

Practice location:
  • Phone: 253-220-6183
  • Fax:
Mailing address:
  • Phone: 425-891-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC60913258
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: