Healthcare Provider Details

I. General information

NPI: 1922383538
Provider Name (Legal Business Name): ROGER ARNOLD ZINKE JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43740 N GROESBECK HWY
CLINTON TWP MI
48036-1139
US

IV. Provider business mailing address

43740 N GROESBECK HWY
CLINTON TWP MI
48036-1139
US

V. Phone/Fax

Practice location:
  • Phone: 586-466-4143
  • Fax:
Mailing address:
  • Phone: 586-466-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704274488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: