Provider Demographics
NPI:1710636279
Name:ZENK, MADISON CLAIRE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:ZENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:CLAIRE
Other - Last Name:ZENK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:617 S 31ST ST APT 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1445
Mailing Address - Country:US
Mailing Address - Phone:970-324-6088
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD.
Practice Address - Street 2:4TH FLOOR, MEB
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-381-6800
Practice Address - Fax:704-381-6841
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program