Healthcare Provider Details

I. General information

NPI: 1457388803
Provider Name (Legal Business Name): CONNIE B. ZINN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 OFFICE PARK DR
OXFORD MS
38655-3597
US

IV. Provider business mailing address

2020 EXETER RD
GERMANTOWN TN
38138-3945
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-9888
  • Fax: 334-244-1830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR617105
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: