Provider Demographics
NPI:1871995571
Name:VAN OOYEN, ZACHERY (RN,)
Entity type:Individual
Prefix:
First Name:ZACHERY
Middle Name:
Last Name:VAN OOYEN
Suffix:
Gender:M
Credentials:RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4103
Mailing Address - Country:US
Mailing Address - Phone:719-583-4364
Mailing Address - Fax:719-583-4375
Practice Address - Street 1:101 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4103
Practice Address - Country:US
Practice Address - Phone:719-583-4364
Practice Address - Fax:719-583-4375
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0196175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse