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General NPI Number Information
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NPI Number | 1306669361
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Entity Type | Individual
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Provider Name | NICOLE ZAJAC RN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6099
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Country | US
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Telephone | 219-886-4710
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | HEBRON
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State | IN
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Zip | 46341-0094
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Country | US
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Telephone | 219-671-8824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28267941A
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License Number State | IN
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