Healthcare Provider Details

I. General information

NPI: 1407924707
Provider Name (Legal Business Name): DONNA ZAWISA RINNAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD
SALINE MI
48176-9773
US

IV. Provider business mailing address

5881 FENTON RD
FENTON MI
48430-9561
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4587
  • Fax:
Mailing address:
  • Phone: 810-265-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301007598
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301007598
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007598
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: