Provider Demographics
NPI:1992243398
Name:ZERRUDO, NORBEROSE TAYSON (RN)
Entity type:Individual
Prefix:
First Name:NORBEROSE
Middle Name:TAYSON
Last Name:ZERRUDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4013
Mailing Address - Country:US
Mailing Address - Phone:715-955-4175
Mailing Address - Fax:
Practice Address - Street 1:1017 W PARK ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4013
Practice Address - Country:US
Practice Address - Phone:715-955-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137910-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI137910-30OtherREGISTERED NURSE