Provider Demographics
NPI:1821547886
Name:ZAUROV, MICHAEL (PMHNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ZAUROV
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 12TH ST CUTOFF SE STE 120
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1754
Mailing Address - Country:US
Mailing Address - Phone:971-599-3411
Mailing Address - Fax:971-999-0906
Practice Address - Street 1:4035 12TH ST CUTOFF SE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1754
Practice Address - Country:US
Practice Address - Phone:971-599-3411
Practice Address - Fax:971-999-0906
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201700161NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health