Healthcare Provider Details

I. General information

NPI: 1871646208
Provider Name (Legal Business Name): MRS. MARILYN ALICE ZITAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PENNY ZITAR RN

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S CANYON RIM
MESA AZ
85212-2134
US

IV. Provider business mailing address

6122 E COLBY ST
MESA AZ
85205-7553
US

V. Phone/Fax

Practice location:
  • Phone: 480-984-3216
  • Fax: 480-380-0105
Mailing address:
  • Phone: 480-396-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN080467
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: