Provider Demographics
NPI:1619765773
Name:REAL MARTIATU, ZUSSET
Entity type:Individual
Prefix:
First Name:ZUSSET
Middle Name:
Last Name:REAL MARTIATU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S ROSE LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6860
Mailing Address - Country:US
Mailing Address - Phone:402-942-5445
Mailing Address - Fax:
Practice Address - Street 1:116 S ROSE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3682
Practice Address - Country:US
Practice Address - Phone:402-942-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NEH14282348372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant