Provider Demographics
NPI:1134278815
Name:MARY ANNE ZEH, A.P.R.N., C.S., LLC
Entity Type:Organization
Organization Name:MARY ANNE ZEH, A.P.R.N., C.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-649-4477
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-0320
Mailing Address - Country:US
Mailing Address - Phone:860-649-4477
Mailing Address - Fax:860-649-4470
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:SUITE C2
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6050
Practice Address - Country:US
Practice Address - Phone:860-649-4477
Practice Address - Fax:860-649-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001682364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT165718OtherVALUE OPTIONS
CT400001682CT01OtherANTHEM
CT211897000OtherMAGELLAN
=========0004OtherCIGNA BEHAVIORAL HEALTH
CT890000240Medicare PIN