Healthcare Provider Details

I. General information

NPI: 1164933891
Provider Name (Legal Business Name): PETE MICHAEL ZENTKOVICH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SHELDON AVE
FAIRCHANCE PA
15436-1022
US

IV. Provider business mailing address

5 SHELDON AVE
FAIRCHANCE PA
15436-1022
US

V. Phone/Fax

Practice location:
  • Phone: 724-322-4401
  • Fax:
Mailing address:
  • Phone: 724-322-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN583935
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: