Provider Demographics
NPI:1710252630
Name:ZYCH, ANITA MARIE (MSRN)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:ZYCH
Suffix:
Gender:F
Credentials:MSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 STARR AVE
Mailing Address - Street 2:PO BOX 10015
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2456
Mailing Address - Country:US
Mailing Address - Phone:419-936-7573
Mailing Address - Fax:
Practice Address - Street 1:1425 STARR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2456
Practice Address - Country:US
Practice Address - Phone:419-936-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH394779163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse