Healthcare Provider Details

I. General information

NPI: 1396301263
Provider Name (Legal Business Name): ALEXANDRA ZAMMIT RUBEL DNP, ARNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 12TH AVE NE
OLYMPIA WA
98506-5175
US

IV. Provider business mailing address

9222 GOODMAN AVE
GIG HARBOR WA
98332-1021
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60961159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: