Individual provider Active NPI

Wendy Zyzniewski, FNP

  • Family Nurse Practitioner
  • Roseburg, OR
National Provider Identifier
1609070531
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200750062NP Issued in OR
Practice address
780 NW Garden Valley Blvd Ste 310
Roseburg, OR 97471-2298
Phone
(541) 672-4885
Fax
(541) 672-4541
NPI assigned
Jun 13, 2007
Last updated
Mar 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 200750062NP OR Primary

Addresses

Primary practice location

780 NW Garden Valley Blvd Ste 310
Roseburg, OR 97471-2298

Mailing address

760 Primrose Dr
Sutherlin, OR 97479-9562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100326000426 OR Practitioner - Nurse Practitioner 4880720069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

780 NW Garden Valley Blvd
Roseburg, OR 97471-6515
Phone (541) 672-4885

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
200750062NPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC Current Accepting new patients
Icco, LLC CurrentSince May 24, 2021 Accepting new patients
Icco LLC CurrentSince May 24, 2021 Accepting new patients
Icco, LLC Past Accepting new patients

Locations

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

1740 NW Goetz St
Roseburg, OR 97471
Phone (541) 672-4789

780 NW Garden Valley Blvd
Roseburg, OR 97471
Phone (541) 672-4885

780 NW Garden Valley Blvd
Ste 310
Roseburg, OR 97471
Phone (541) 672-4885

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1609070531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 PRIMROSE DR",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 NW GARDEN VALLEY BLVD STE 310",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712298",
            "telephone_number": "541-672-4885",
            "fax_number": "541-672-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZYZNIEWSKI",
        "first_name": "WENDY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200750062NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.