Healthcare Provider Details

I. General information

NPI: 1548664501
Provider Name (Legal Business Name): JEAN ZINGSHEIM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 SOUTH 31ST. STREET
GREENFIELD WI
53221-5611
US

IV. Provider business mailing address

4945 SOUTH 31ST. STREET
GREENFIELD WI
53221-5611
US

V. Phone/Fax

Practice location:
  • Phone: 414-840-1511
  • Fax:
Mailing address:
  • Phone: 414-840-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number302611-031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: