Provider Demographics
NPI:1528536885
Name:ZACH, MARY PAIGE (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAIGE
Last Name:ZACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 W A ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5650
Mailing Address - Country:US
Mailing Address - Phone:402-461-7578
Mailing Address - Fax:402-461-7509
Practice Address - Street 1:201 N MARIAN RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4671
Practice Address - Country:US
Practice Address - Phone:402-461-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76935163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty