Provider Demographics
NPI:1538502646
Name:ZAWISZA, EILEEN A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:A
Last Name:ZAWISZA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:A
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3562 DOXTATOR RD
Mailing Address - Street 2:
Mailing Address - City:DURHAMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13054
Mailing Address - Country:US
Mailing Address - Phone:315-264-3963
Mailing Address - Fax:
Practice Address - Street 1:3562 DOXTATOR RD
Practice Address - Street 2:
Practice Address - City:DURHAMVILLE
Practice Address - State:NY
Practice Address - Zip Code:13054-3158
Practice Address - Country:US
Practice Address - Phone:315-264-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303379-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse