Provider Demographics
NPI:1376382606
Name:ZILLYETTE, SARA JEAN (NC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:ZILLYETTE
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:WA
Mailing Address - Zip Code:98559-0924
Mailing Address - Country:US
Mailing Address - Phone:360-593-8955
Mailing Address - Fax:
Practice Address - Street 1:5391 US HIGHWAY 12 # 6
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9274
Practice Address - Country:US
Practice Address - Phone:360-593-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10090978376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide