Healthcare Provider Details

I. General information

NPI: 1184030363
Provider Name (Legal Business Name): SHELLEY MARIE ZINO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY ZOONZ ZINO RN

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-3100
  • Fax:
Mailing address:
  • Phone: 919-873-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number161034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: