1821873423 NPI number — TYANA MARIE ZIVEC DPT

Table of content: TYANA MARIE ZIVEC DPT (NPI 1821873423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821873423 NPI number — TYANA MARIE ZIVEC DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIVEC
Provider First Name:
TYANA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821873423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 RIGNEY RD APT C25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEILACOOM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98388-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-415-5821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BRIAN D ALLGOOD ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
BLDG 3031
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
50-333-7227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  212990 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)