Provider Demographics
NPI:1689048829
Name:ZIZILAS, DORINA
Entity Type:Individual
Prefix:MRS
First Name:DORINA
Middle Name:
Last Name:ZIZILAS
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 1:44578 BAYVIEW AVE
Mailing Address - Street 2:APT. 12301
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7044
Mailing Address - Country:US
Mailing Address - Phone:248-971-4764
Mailing Address - Fax:
Practice Address - Street 1:44578 BAYVIEW AVE
Practice Address - Street 2:APT. 12301
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7044
Practice Address - Country:US
Practice Address - Phone:248-971-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-28
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703109714164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse