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NPI Code Detail

MEDICARE: DR. MARY ZANDER PH.D.

MEDICARE:  DR. MARY  ZANDER  PH.D.
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
1103TC0700XClinical Psychologist613WY

General Provider Information

NPI Number : 1891181509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ZANDER PH.D.
Provider Business Mailing Address
First Line : 5427 E MADERA ST BLDG 4339
Second Line :
City : DAVIS-MONTHAN AFB
State : AZ
Zip : 85708
Country : US
Telephone Number : 520-228-4357
Fax Number :
Provider Business Practice Location Address
First Line : 2050A 2ND ST SE
Second Line :
City : KIRTLAND AFB
State : NM
Zip : 87117-5522
Country : US
Telephone Number : 520-228-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2015
Last Update Date : 04/05/2023

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