Provider Demographics
NPI:1215215207
Name:ZLEVOR, MARY RITA (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RITA
Last Name:ZLEVOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1841
Mailing Address - Country:US
Mailing Address - Phone:262-412-6331
Mailing Address - Fax:
Practice Address - Street 1:2306 SPRING ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1841
Practice Address - Country:US
Practice Address - Phone:262-412-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178282-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse