Provider Demographics
NPI:1306121694
Name:ZIVICH, BETTY ROSEANNE (RN, CDE)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ROSEANNE
Last Name:ZIVICH
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 GARRETSON ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3521
Mailing Address - Country:US
Mailing Address - Phone:703-440-8437
Mailing Address - Fax:
Practice Address - Street 1:6233 GARRETSON ST
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3521
Practice Address - Country:US
Practice Address - Phone:703-220-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001104172163WD0400X
DCRN1028194163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator