Healthcare Provider Details

I. General information

NPI: 1730812488
Provider Name (Legal Business Name): LARISSA JEAN ZDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

12033 AGENCY RD
PARKER AZ
85344-7718
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2137
  • Fax: 928-669-3232
Mailing address:
  • Phone: 928-669-2137
  • Fax: 928-669-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number816190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: