Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60793280 | WA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN60738684 | WA |
NPI | 1053834879 |
---|---|
Provider Name | Mr. Ryan Zagalsky |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2017 |
Last Update Date | 17/03/2018 |