Healthcare Provider Details

I. General information

NPI: 1700158037
Provider Name (Legal Business Name): CATHERINE MARY ZAWACKI RN, BSN, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 VILLAGE GREEN BLVD APT. # 101
ANN ARBOR MI
48105-2780
US

IV. Provider business mailing address

442 VILLAGE GREEN BLVD APT. # 101
ANN ARBOR MI
48105-2780
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-3072
  • Fax:
Mailing address:
  • Phone: 734-994-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704200127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: