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General NPI Number Information
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NPI Number | 1821142738
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Entity Type | Individual
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Provider Name | LISA D ZYLSTRA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 406 SE 131ST AVE STE C305
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City | VANCOUVER
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State | WA
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Zip | 98683-4004
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Country | US
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Telephone | 360-816-0277
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Fax | 360-567-4004
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Provider Business Mailing Address
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Address Line | 24015 NE W H GARNER RD
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City | YACOLT
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State | WA
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Zip | 98675-4303
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Country | US
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Telephone | 360-823-8084
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10004703
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License Number State | WA
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