Provider Demographics
NPI:1255727848
Name:ZAYAC, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZAYAC
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 1:12657 FORDNEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-9592
Mailing Address - Country:US
Mailing Address - Phone:989-865-9603
Mailing Address - Fax:
Practice Address - Street 1:12657 FORDNEY RD
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-9592
Practice Address - Country:US
Practice Address - Phone:989-865-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant