Provider Demographics
NPI:1710605357
Name:NASSAR, ZANE
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:NASSAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 FOX PROWL LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8408
Mailing Address - Country:US
Mailing Address - Phone:405-401-6978
Mailing Address - Fax:
Practice Address - Street 1:17200 FOX PROWL LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8408
Practice Address - Country:US
Practice Address - Phone:405-401-6978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program