Provider Demographics
NPI:1720414188
Name:ZACHOW, CONNIE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:ZACHOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:REMILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 BENNETT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-3210
Mailing Address - Country:US
Mailing Address - Phone:607-434-3221
Mailing Address - Fax:
Practice Address - Street 1:21 BENNETT HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-3210
Practice Address - Country:US
Practice Address - Phone:607-434-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305578164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse