Provider Demographics
NPI:1821691502
Name:VAN ZANDT, CAITLYN ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ELIZABETH
Last Name:VAN ZANDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 N 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1100
Mailing Address - Country:US
Mailing Address - Phone:623-412-4778
Mailing Address - Fax:623-412-4786
Practice Address - Street 1:10401 N 63RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1100
Practice Address - Country:US
Practice Address - Phone:623-412-4778
Practice Address - Fax:623-412-4786
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247709163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool