Basic Information
| Provider Information | |||||||||
| NPI: | 1982125597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZDUNICH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 RANCH RD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974671720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412712163 | ||||||||
| FaxNumber: | 5412714058 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 RANCH RD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974671720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412712163 | ||||||||
| FaxNumber: | 5412714058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2017 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 201802256NP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | ARNP9390831 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.