Provider Demographics
NPI:1689102881
Name:ZWIEBEL, KATHERINE T (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:T
Last Name:ZWIEBEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:200 SAINT CLAIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2400
Practice Address - Country:US
Practice Address - Phone:419-394-9522
Practice Address - Fax:419-394-9523
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020488363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34-1689161OtherGROUP TAX ID
OH0405065OtherMEDICAID GROUP
OH9934723OtherMEDICARE GROUP PTAN
OHH571042OtherMEDICARE PTAN
OH0228505Medicaid