Healthcare Provider Details

I. General information

NPI: 1134278815
Provider Name (Legal Business Name): MARY ANNE ZEH, A.P.R.N., C.S., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/25/2020
Certification Date: 12/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MAIN ST SUITE C2
MANCHESTER CT
06040-6050
US

IV. Provider business mailing address

PO BOX 320
THOMPSON CT
06277-0320
US

V. Phone/Fax

Practice location:
  • Phone: 860-649-4477
  • Fax: 860-649-4470
Mailing address:
  • Phone: 860-649-4477
  • Fax: 860-649-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001682
License Number StateCT

VIII. Authorized Official

Name: MARY ANNE ZEH
Title or Position: OWNER
Credential: A.P.R.N.
Phone: 860-649-4477