Provider Demographics
NPI:1255640702
Name:ZINK, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ZINK
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:PO BOX 50335
Mailing Address - Street 2:
Mailing Address - City:PARKS
Mailing Address - State:AZ
Mailing Address - Zip Code:86018-0335
Mailing Address - Country:US
Mailing Address - Phone:928-221-7830
Mailing Address - Fax:
Practice Address - Street 1:13126 TRINITY RANCH ROAD
Practice Address - Street 2:
Practice Address - City:PARKS
Practice Address - State:AZ
Practice Address - Zip Code:86018-0335
Practice Address - Country:US
Practice Address - Phone:928-221-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1420774385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child