Basic Information
| Provider Information | |||||||||
| NPI: | 1548809502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZITKOVICH | ||||||||
| FirstName: | ANASTASIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12923 STATE ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982738010 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1315 E DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607345410 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2019 | ||||||||
| LastUpdateDate: | 12/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Home Health Aide |
No ID Information.