Healthcare Provider Details

I. General information

NPI: 1093758765
Provider Name (Legal Business Name): JOHN C ZIEBARTH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

IV. Provider business mailing address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-1049
  • Fax:
Mailing address:
  • Phone: 775-753-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA481
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: