Provider Demographics
NPI:1851671895
Name:ZACH, CAROL (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ZACH
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:N5802 SUGAR RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502-9703
Mailing Address - Country:US
Mailing Address - Phone:608-862-1999
Mailing Address - Fax:
Practice Address - Street 1:N5802 SUGAR RIVER PKWY
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:WI
Practice Address - Zip Code:53502-9703
Practice Address - Country:US
Practice Address - Phone:608-862-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165296-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse