Healthcare Provider Details

I. General information

NPI: 1942330329
Provider Name (Legal Business Name): MARIE ZANNINI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17032 W SURPRISE FARMS LOOP S
SURPRISE AZ
85388-1581
US

IV. Provider business mailing address

19202 N MOHAVE SAGE WAY
SURPRISE AZ
85387-7504
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-8640
  • Fax: 623-523-8611
Mailing address:
  • Phone: 623-523-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP037857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: