Provider Demographics
NPI:1457821407
Name:ZAJAC, MARCIE
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:STE 240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-366-5544
Mailing Address - Fax:702-988-5347
Practice Address - Street 1:861 CORONADO CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3992
Practice Address - Country:US
Practice Address - Phone:702-823-9799
Practice Address - Fax:702-925-6663
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily