Provider Demographics
NPI:1326186230
Name:ZADRA, THERESE P (CRNFA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:P
Last Name:ZADRA
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11482
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85271-1482
Mailing Address - Country:US
Mailing Address - Phone:480-988-3732
Mailing Address - Fax:480-988-3742
Practice Address - Street 1:2419 S ALLRED DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3021
Practice Address - Country:US
Practice Address - Phone:480-980-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN052076163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant