Healthcare Provider Details

I. General information

NPI: 1194632224
Provider Name (Legal Business Name): MARK LOGAN ZIZZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

212 VINCENT AVE UNIT B
DURHAM NC
27705-6213
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax:
Mailing address:
  • Phone: 336-504-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number325548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: