Healthcare Provider Details

I. General information

NPI: 1376187526
Provider Name (Legal Business Name): KATARINA HEIDI ZEENDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVE
WESTMINSTER MD
21157-5726
US

IV. Provider business mailing address

15603 WILDROSE CT
NEW WINDSOR MD
21776-7601
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-3000
  • Fax:
Mailing address:
  • Phone: 443-540-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007353
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: