MEDICARE: MR. JOHN JOSEPH ZAROLA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R12482	NM

General Provider Information

NPI Number	:	1336149350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JOSEPH ZAROLA CRNA

Provider Business Mailing Address
First Line	:	POB 1231
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-1231
Country	:	US
Telephone Number	:	505-929-0414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 ROOSEVELT AVE
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020
Country	:	US
Telephone Number	:	505-287-4446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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