Healthcare Provider Details

I. General information

NPI: 1477064665
Provider Name (Legal Business Name): JILL MARIE ZDAN NMD, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL MARIE SULLIVAN

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 3025
PHOENIX AZ
85020-2428
US

IV. Provider business mailing address

18012 W LAWRENCE LN
WADDELL AZ
85355-7515
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-4628
  • Fax: 602-944-2805
Mailing address:
  • Phone: 928-460-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9838
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number17-1652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: