Provider Demographics
NPI:1881016244
Name:ZAISER, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:ZAISER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 N TATUM BLVD
Mailing Address - Street 2:STE 200-629
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:480-307-6790
Mailing Address - Fax:480-307-6938
Practice Address - Street 1:10645 N TATUM BLVD
Practice Address - Street 2:STE 200-629
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3068
Practice Address - Country:US
Practice Address - Phone:480-307-6790
Practice Address - Fax:480-307-6938
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270961511OtherTAX ID