Healthcare Provider Details

I. General information

NPI: 1376382606
Provider Name (Legal Business Name): SARA JEAN ZILLYETTE NC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5391 US HIGHWAY 12 # 6
ELMA WA
98541-9274
US

IV. Provider business mailing address

PO BOX 924
MALONE WA
98559-0924
US

V. Phone/Fax

Practice location:
  • Phone: 360-593-8955
  • Fax:
Mailing address:
  • Phone: 360-593-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10090978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: