Provider Demographics
NPI:1003011362
Name:ZIEMBA, JEAN A (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:ZIEMBA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:PIGNATELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1113 N GLENCOVE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2302
Mailing Address - Country:US
Mailing Address - Phone:315-433-8546
Mailing Address - Fax:
Practice Address - Street 1:25 CHAUCER CIR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-8254
Practice Address - Country:US
Practice Address - Phone:315-635-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512062-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02721497Medicaid