Provider Demographics
NPI:1689877466
Name:ZEMBOWER, GARRY LEE JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:LEE
Last Name:ZEMBOWER
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 W SWEET CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9567
Mailing Address - Country:US
Mailing Address - Phone:317-529-8310
Mailing Address - Fax:
Practice Address - Street 1:6508 W SWEET CREEK DR
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9567
Practice Address - Country:US
Practice Address - Phone:317-529-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27040913A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN27040913AOtherPRACTICAL NURSING LICENSE