Provider Demographics
NPI:1700418217
Name:WILBURD, ZANETTA FAYE (RN)
Entity Type:Individual
Prefix:
First Name:ZANETTA
Middle Name:FAYE
Last Name:WILBURD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2912
Mailing Address - Country:US
Mailing Address - Phone:501-398-6924
Mailing Address - Fax:
Practice Address - Street 1:316 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2912
Practice Address - Country:US
Practice Address - Phone:501-398-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR108658163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR237239732Medicaid