Healthcare Provider Details

I. General information

NPI: 1558666594
Provider Name (Legal Business Name): AMY M ZIELKE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY M STINSON CRNA

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7320
  • Fax: 757-668-9735
Mailing address:
  • Phone: 800-242-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: