Healthcare Provider Details

I. General information

NPI: 1023663549
Provider Name (Legal Business Name): TAYLOR ZIBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 BEN FRANKLIN ST
VERONA WI
53593-9475
US

IV. Provider business mailing address

1702 BEN FRANKLIN ST
VERONA WI
53593-9475
US

V. Phone/Fax

Practice location:
  • Phone: 920-202-0222
  • Fax:
Mailing address:
  • Phone: 920-202-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237945-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: