Basic Information
| Provider Information | |||||||||
| NPI: | 1467538215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZELLNER | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3209 S 23RD ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532725127 | ||||||||
| FaxNumber: | 2532720811 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 S MERIDIAN STE 305 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983717590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538413933 | ||||||||
| FaxNumber: | 2538487970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA60184603 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA60184603 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P01425765 | 01 | WA | RR MEDICARE | OTHER | 0272067 | 01 | WA | L&I AND CRIME VICTIMS | OTHER | V998 | 01 | WA | TRI-WEST (TRICARE) | OTHER | 1467538215 | 05 | WA | MEDICAID |