Healthcare Provider Details

I. General information

NPI: 1104801711
Provider Name (Legal Business Name): ANNA ZINCHENKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIBERTY STREET
BROCKTON MA
02301
US

IV. Provider business mailing address

680 CENTRE STREET
BROCKTON MA
02302
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0400
  • Fax: 508-894-0332
Mailing address:
  • Phone: 508-941-7885
  • Fax: 508-941-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number216319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: