Basic Information
| Provider Information | |||||||||
| NPI: | 1124337969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZACHARA | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | O. | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 KIRKLAND AVE APT 144 | ||||||||
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| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980336234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064277455 | ||||||||
| FaxNumber: | 4252841727 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 NE 132ND ST | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980342831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258212000 | ||||||||
| FaxNumber: | 4252841727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 09/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP60184986 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.