Provider Demographics
NPI:1609070531
Name:ZYZNIEWSKI, WENDY (FNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ZYZNIEWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 NW GARDEN VALLEY BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2298
Practice Address - Country:US
Practice Address - Phone:541-672-4885
Practice Address - Fax:541-672-4541
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750062NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily