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General NPI Number Information
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NPI Number | 1700087566
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Entity Type | Individual
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Provider Name | GINA ZAGAROLI N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 505 HAZEN ST SUITE 204
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City | PAW PAW
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State | MI
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Zip | 49079-1070
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Country | US
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Telephone | 269-657-6058
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Fax | 269-657-5996
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Provider Business Mailing Address
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Address Line | 6629 CYPRESS ST
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City | PORTAGE
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State | MI
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Zip | 49024-3203
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Country | US
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Telephone |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 4704122427
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License Number State | MI
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