Provider Demographics
NPI:1073005443
Name:DEFFINBAUGH, ZACHARY LEE (FNP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LEE
Last Name:DEFFINBAUGH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 3RD AVE # A
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3354
Mailing Address - Country:US
Mailing Address - Phone:509-388-2345
Mailing Address - Fax:509-388-0291
Practice Address - Street 1:100 W 3RD AVE # A
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3354
Practice Address - Country:US
Practice Address - Phone:509-388-2345
Practice Address - Fax:509-388-0291
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT130737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily