Healthcare Provider Details

I. General information

NPI: 1558754192
Provider Name (Legal Business Name): JEAN LYNN ZAVADIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANNIE LYNN ZAVADIL RN

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 9TH AVE WEST
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

222 9TH AVE WEST
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-3912
  • Fax: 320-763-6629
Mailing address:
  • Phone: 320-763-3912
  • Fax: 320-763-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR201606-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: