Provider Demographics
NPI:1871625152
Name:ZAMBRANA, KATHRYN COLLEEN (LMP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COLLEEN
Last Name:ZAMBRANA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11935
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1935
Mailing Address - Country:US
Mailing Address - Phone:360-701-6454
Mailing Address - Fax:360-867-4179
Practice Address - Street 1:634 113TH AVE SW # B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-9157
Practice Address - Country:US
Practice Address - Phone:360-701-6454
Practice Address - Fax:360-867-4179
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist