Healthcare Provider Details

I. General information

NPI: 1336819861
Provider Name (Legal Business Name): VIANEY ZITTERKOPF RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PPHD 18 W. 15TH ST.
SCOTTSBLUFF NE
69361
US

IV. Provider business mailing address

PPHD 18 W. 15TH ST.
SCOTTSBLUFF NE
69361
US

V. Phone/Fax

Practice location:
  • Phone: 308-633-2866
  • Fax: 308-487-3682
Mailing address:
  • Phone: 308-633-2866
  • Fax: 308-487-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number67163
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: