Basic Information
Provider Information | |||||||||
NPI: | 1982878914 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZABRISKIE | ||||||||
FirstName: | STACY | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HARMS | ||||||||
OtherFirstName: | STACY | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 714 W PINE STREET | ||||||||
Address2: |   | ||||||||
City: | NEWPORT | ||||||||
State: | WA | ||||||||
PostalCode: | 99156 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094473139 | ||||||||
FaxNumber: | 5094472911 | ||||||||
Practice Location | |||||||||
Address1: | 714 W PINE ST | ||||||||
Address2: |   | ||||||||
City: | NEWPORT | ||||||||
State: | WA | ||||||||
PostalCode: | 991569046 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094474885 | ||||||||
FaxNumber: | 5094472911 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/22/2008 | ||||||||
LastUpdateDate: | 07/28/2017 | ||||||||
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 | 208600000X | 2013023318 | MO | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208600000X | MD60692745 | WA | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.