Provider Demographics
NPI:1326328691
Name:TAM, ZONETTE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ZONETTE
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 W TURNEY AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-6323
Mailing Address - Country:US
Mailing Address - Phone:623-242-7165
Mailing Address - Fax:
Practice Address - Street 1:1210 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1225
Practice Address - Country:US
Practice Address - Phone:602-257-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN167114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse