Healthcare Provider Details

I. General information

NPI: 1770309213
Provider Name (Legal Business Name): ZVINASHE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 W DESERT VISTA TRL
PHOENIX AZ
85085-3706
US

IV. Provider business mailing address

2534 W DESERT VISTA TRL
PHOENIX AZ
85085-3706
US

V. Phone/Fax

Practice location:
  • Phone: 602-738-2820
  • Fax:
Mailing address:
  • Phone: 602-738-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN141407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: