Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | G54501 | CA |
Y | 207VG0400X | Gynecologist | MD00036846 | WA |
NPI | 1053335315 |
---|---|
Provider Name | Dr. Theresa Ann Zumwalt |
First Address | Rollingbay, WA 98061-0716 |
Second Address | Bainbridge Island, WA 98110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 05/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8236663 | (05) | WA |
A52732 | (02) |