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General NPI Number Information
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NPI Number | 1174282768
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Entity Type | Individual
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Provider Name | ZOE CHRISTINA BIRT PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2021
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Last Update Date | 12/11/2021
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Provider Practice Location Address
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Address Line | 100 E JACKSON AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-3692
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Country | US
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Telephone | 509-933-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 11450 W AZURE DR
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City | BOISE
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State | ID
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Zip | 83713-7876
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Country | US
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Telephone | 208-954-4847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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