| Fishers Landing Primary Care | |
|
406 Se 131st Ave Ste C Vancouver WA 98683-4004 | |
| (360) 816-0277 | |
| (360) 567-4004 |
| Full Name | Fishers Landing Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 406 Se 131st Ave Ste C, Vancouver, Washington |
| Authorized Official Name and Position | L Katherine Moon (OWNER) |
| Authorized Official Contact | 3608160277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fishers Landing Primary Care 6715 Ne 63rd St Ste 436 Vancouver WA 98661-1980 Ph: (360) 816-0277 | Fishers Landing Primary Care 406 Se 131st Ave Ste C Vancouver WA 98683-4004 Ph: (360) 816-0277 |
| NPI Number | 1275295164 |
|---|---|
| Provider Enumeration Date | 10/08/2021 |
| Last Update Date | 02/06/2022 |
| Certification Date | 02/06/2022 |
| Medicare PECOS PAC ID | 1254721657 |
|---|---|
| Medicare Enrollment ID | O20211129000846 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275295164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Lisa D Zylstra |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821142738 PECOS PAC ID: 6002901154 Enrollment ID: I20090825000551 |
| Provider Name | L Katherine Moon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518992494 PECOS PAC ID: 9638367576 Enrollment ID: I20101220000812 |
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