Healthcare Provider Details

I. General information

NPI: 1114348869
Provider Name (Legal Business Name): ZACHARY ZETTLE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DRIVE
PITTSBURGH PA
15240
US

IV. Provider business mailing address

109 SPRUCE VALLEY DR
PITTSBURGH PA
15229-2168
US

V. Phone/Fax

Practice location:
  • Phone: 866-482-7488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN593607
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: