Provider Demographics
NPI:1871544080
Name:GUDZYUK, ZHANNA (NP)
Entity type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:GUDZYUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9379
Mailing Address - Country:US
Mailing Address - Phone:253-922-5262
Mailing Address - Fax:253-922-5299
Practice Address - Street 1:2748 MILTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9379
Practice Address - Country:US
Practice Address - Phone:253-922-5262
Practice Address - Fax:253-922-5299
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3327301363LF0000X
WAAP30007513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0216812OtherSTATE L&I
WA0216812OtherSTATE L&I
S96388Medicare UPIN
WAG8863408Medicare PIN