Provider Demographics
NPI:1942330329
Name:ZANNINI, MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:ZANNINI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19202 N MOHAVE SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-7504
Mailing Address - Country:US
Mailing Address - Phone:623-523-8640
Mailing Address - Fax:
Practice Address - Street 1:17032 W SURPRISE FARMS LOOP S
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1581
Practice Address - Country:US
Practice Address - Phone:623-523-8640
Practice Address - Fax:623-523-8611
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP037857164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ929937Medicaid