Healthcare Provider Details

I. General information

NPI: 1417634247
Provider Name (Legal Business Name): ZELLNER JONES STANDBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZELLNER JONES STANDBACK

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 S 3RD ST
MEMPHIS TN
38109-6234
US

IV. Provider business mailing address

PO BOX 901091
MEMPHIS TN
38190-1091
US

V. Phone/Fax

Practice location:
  • Phone: 901-785-5878
  • Fax:
Mailing address:
  • Phone: 901-785-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number7LJGXNNLJS
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: