Provider Demographics
NPI:1912588047
Name:SOUNTHALA, ZHERYL BALDONADO (ARNP)
Entity type:Individual
Prefix:
First Name:ZHERYL
Middle Name:BALDONADO
Last Name:SOUNTHALA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ZHERYL
Other - Middle Name:B
Other - Last Name:BALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:550 17TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-861-8550
Practice Address - Fax:206-861-8551
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60066995163W00000X
WAAP61148962363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2185119Medicaid