Provider Demographics
NPI:1629473780
Name:ZERTUCHE, DOLORES
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:
Last Name:ZERTUCHE
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 1:30 HARVARD PL
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-5529
Mailing Address - Country:US
Mailing Address - Phone:325-695-5855
Mailing Address - Fax:
Practice Address - Street 1:30 HARVARD PL
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-5529
Practice Address - Country:US
Practice Address - Phone:325-695-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily