Provider Demographics
NPI:1871646208
Name:ZITAR, MARILYN ALICE
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ALICE
Last Name:ZITAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:ZITAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6122 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7553
Mailing Address - Country:US
Mailing Address - Phone:480-396-4879
Mailing Address - Fax:
Practice Address - Street 1:3045 S CANYON RIM
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2134
Practice Address - Country:US
Practice Address - Phone:480-984-3216
Practice Address - Fax:480-380-0105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN080467163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool