Healthcare Provider Details

I. General information

NPI: 1700418217
Provider Name (Legal Business Name): ZANETTA FAYE WILBURD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W MAIN ST
CABOT AR
72023-2912
US

IV. Provider business mailing address

316 W MAIN ST
CABOT AR
72023-2912
US

V. Phone/Fax

Practice location:
  • Phone: 501-398-6924
  • Fax:
Mailing address:
  • Phone: 501-398-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR108658
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: