Provider Demographics
NPI:1568494334
Name:ZAMBITO, REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ZAMBITO
Suffix:
Gender:F
Credentials:NP
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 984
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:473 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-9006
Practice Address - Country:US
Practice Address - Phone:360-457-5139
Practice Address - Fax:360-841-7055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9637521Medicaid
WA9637521Medicaid
WAAB39824Medicare ID - Type Unspecified
WAQ00138Medicare UPIN