Provider Demographics
NPI:1497455935
Name:ZERRUDO, MARK BALANDRA (RN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:BALANDRA
Last Name:ZERRUDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LOS RIOS DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-8928
Mailing Address - Country:US
Mailing Address - Phone:972-632-8363
Mailing Address - Fax:
Practice Address - Street 1:230 E HUNT ST STE 201-202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3820
Practice Address - Country:US
Practice Address - Phone:972-632-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse