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General NPI Number Information
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NPI Number | 1467950782
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Entity Type | Individual
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Provider Name | ZACHARY ADAM SULLIVAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 9230 SKY ISLAND DR E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-7385
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Country | US
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Telephone | 253-750-6000
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Fax | 253-627-7880
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Provider Business Mailing Address
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Address Line | 9230 SKY ISLAND DR E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-7385
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Country | US
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Telephone | 253-750-6000
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Fax | 253-627-7880
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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 | PA60831973
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License Number State | WA
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