Provider Demographics
NPI:1902644909
Name:ZETTL, JENNIFER N (DNP,FNP-C, CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:ZETTL
Suffix:
Gender:F
Credentials:DNP,FNP-C, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-8246
Mailing Address - Country:US
Mailing Address - Phone:605-673-3900
Mailing Address - Fax:855-540-2396
Practice Address - Street 1:1369 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-8246
Practice Address - Country:US
Practice Address - Phone:605-673-3900
Practice Address - Fax:855-540-2396
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily