Provider Demographics
NPI:1417578162
Name:ZATKOVIC, JUSTINE JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:JEAN
Last Name:ZATKOVIC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868 WESTSIDE SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9325
Mailing Address - Country:US
Mailing Address - Phone:989-903-5560
Mailing Address - Fax:
Practice Address - Street 1:6868 WESTSIDE SAGINAW RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9325
Practice Address - Country:US
Practice Address - Phone:989-903-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703122632164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse