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NPI Code Detail

MEDICARE: JUSTINE JEAN ZATKOVIC LPN

MEDICARE: JUSTINE JEAN ZATKOVIC LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse4703122632MI

General Provider Information

NPI Number : 1417578162
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE JEAN ZATKOVIC LPN
Provider Business Mailing Address
First Line : 6868 WESTSIDE SAGINAW RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9325
Country : US
Telephone Number : 989-903-5560
Fax Number :
Provider Business Practice Location Address
First Line : 6868 WESTSIDE SAGINAW RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9325
Country : US
Telephone Number : 989-903-5560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2020
Last Update Date : 05/05/2020

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Directions to “ JUSTINE JEAN ZATKOVIC LPN” Practice Location

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