Healthcare Provider Details

I. General information

NPI: 1700087566
Provider Name (Legal Business Name): GINA ZAGAROLI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 HAZEN ST SUITE 204
PAW PAW MI
49079-1070
US

IV. Provider business mailing address

6629 CYPRESS ST
PORTAGE MI
49024-3203
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-6058
  • Fax: 269-657-5996
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704122427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: