Healthcare Provider Details

I. General information

NPI: 1497008437
Provider Name (Legal Business Name): ZETTA BYRD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZETTA OSTRANDER

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

PO BOX 812
KASILOF AK
99610-0812
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4404
  • Fax: 907-714-4696
Mailing address:
  • Phone: 907-260-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number9858
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: