Provider Demographics
NPI:1437974672
Name:ZAVISTOSKI, BRENDA (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:ZAVISTOSKI
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 1:1240 WOODBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9298
Mailing Address - Country:US
Mailing Address - Phone:570-878-7102
Mailing Address - Fax:
Practice Address - Street 1:1240 WOODBERRY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-9298
Practice Address - Country:US
Practice Address - Phone:570-878-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN311726L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse