Healthcare Provider Details

I. General information

NPI: 1023258829
Provider Name (Legal Business Name): JANE E ZWOLSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 W MAIN ST
TIPP CITY OH
45371-2803
US

IV. Provider business mailing address

1487 W MAIN ST
TIPP CITY OH
45371-2803
US

V. Phone/Fax

Practice location:
  • Phone: 937-667-0776
  • Fax:
Mailing address:
  • Phone: 937-667-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number102453
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: