Healthcare Provider Details

I. General information

NPI: 1205094885
Provider Name (Legal Business Name): MLZ HEALTH CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PEPPERBUSH DR
CLINTON CT
06413-1168
US

IV. Provider business mailing address

17 PEPPERBUSH DR
CLINTON CT
06413-1168
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-5302
  • Fax: 860-669-5302
Mailing address:
  • Phone: 860-669-5302
  • Fax: 860-669-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA L ZANDONELLA
Title or Position: OWNER
Credential: APRN
Phone: 860-575-0349