Healthcare Provider Details

I. General information

NPI: 1235226200
Provider Name (Legal Business Name): VICKIE THERESA ZYLA CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 ANDERSON RD
WHITE HALL MD
21161-9021
US

IV. Provider business mailing address

2910 ANDERSON RD
WHITE HALL MD
21161-9021
US

V. Phone/Fax

Practice location:
  • Phone: 410-878-2463
  • Fax:
Mailing address:
  • Phone: 410-878-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRO83872
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: