Healthcare Provider Details

I. General information

NPI: 1265012033
Provider Name (Legal Business Name): COREY ZEIG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 ELM ST W
ANNANDALE MN
55302-1123
US

IV. Provider business mailing address

20408 JUNE GRASS DR
BIG LAKE MN
55309-5201
US

V. Phone/Fax

Practice location:
  • Phone: 320-274-3062
  • Fax:
Mailing address:
  • Phone: 612-801-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1310058
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: