Provider Demographics
NPI:1871176099
Name:ZETTELMEIER, LEAH (BSN, RN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ZETTELMEIER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:BUMGARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-0941
Mailing Address - Country:US
Mailing Address - Phone:336-467-9059
Mailing Address - Fax:
Practice Address - Street 1:204 NORTHVIEW PLZ
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3173
Practice Address - Country:US
Practice Address - Phone:336-467-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse