Provider Demographics
NPI:1871316935
Name:RETTIG, ZAVYON ANDRA
Entity type:Individual
Prefix:
First Name:ZAVYON
Middle Name:ANDRA
Last Name:RETTIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9306 COUNTY ROAD 476 S
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-8255
Mailing Address - Country:US
Mailing Address - Phone:903-854-2281
Mailing Address - Fax:
Practice Address - Street 1:9306 COUNTY ROAD 476 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-8255
Practice Address - Country:US
Practice Address - Phone:903-854-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty