Provider Demographics
NPI:1225658909
Name:MACK, ZABRINA DISHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ZABRINA
Middle Name:DISHELLE
Last Name:MACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ZABRINA
Other - Middle Name:DISHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3022 OLD MINDEN RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2477
Mailing Address - Country:US
Mailing Address - Phone:318-741-7314
Mailing Address - Fax:318-741-7441
Practice Address - Street 1:3022 OLD MINDEN RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2477
Practice Address - Country:US
Practice Address - Phone:318-741-7314
Practice Address - Fax:318-741-7441
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN122190163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse