Basic Information
Provider Information | |||||||||
NPI: | 1073500260 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZOCCHI | ||||||||
FirstName: | LININA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JOB, RAGAN | ||||||||
OtherFirstName: | LININA | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ARNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1115 SE 164TH AVE | ||||||||
Address2: | DEPT 358 | ||||||||
City: | VANCOUVER | ||||||||
State: | WA | ||||||||
PostalCode: | 986839324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3605142000 | ||||||||
FaxNumber: | 3605756749 | ||||||||
Practice Location | |||||||||
Address1: | 2312 NE 129TH ST | ||||||||
Address2: |   | ||||||||
City: | VANCOUVER | ||||||||
State: | WA | ||||||||
PostalCode: | 986863236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3606965022 | ||||||||
FaxNumber: | 3606965445 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2005 | ||||||||
LastUpdateDate: | 03/26/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00128186 | WA | N |   | Nursing Service Providers | Registered Nurse |   | 363LA2200X | AP30007101 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 0202237 | 01 | WA | LABOR & IND. | OTHER | 8940109 | 01 | WA | CRIME VICTIMS | OTHER | 27906 | 05 | OR |   | MEDICAID | P00331117 | 01 |   | RR MEDICARE | OTHER | 9646605 | 05 | WA |   | MEDICAID |