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General NPI Number Information
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NPI Number | 1376382606
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Entity Type | Individual
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Provider Name | SARA JEAN ZILLYETTE NC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 5391 US HIGHWAY 12 # 6
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City | ELMA
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State | WA
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Zip | 98541-9274
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Country | US
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Telephone | 360-593-8955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 924
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City | MALONE
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State | WA
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Zip | 98559-0924
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Country | US
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Telephone | 360-593-8955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 10090978
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License Number State | WA
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