Provider Demographics
NPI:1760407969
Name:ZAK, CASSANDRA JO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:JO
Last Name:ZAK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:2218 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9497
Mailing Address - Country:US
Mailing Address - Phone:419-865-7980
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:ANN ARBOR VA MEDICAL CENTER IIIA
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-213-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI4704233285363LA2200X
OHNP 05378363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMZO969583OtherDEA NUMBER