Provider Demographics
NPI:1700586401
Name:ZIENIEWICZ, MATTIE JEANNETTE
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:JEANNETTE
Last Name:ZIENIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATTIE
Other - Middle Name:JEANNETTE
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5287 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-5733
Mailing Address - Country:US
Mailing Address - Phone:276-298-2802
Mailing Address - Fax:
Practice Address - Street 1:5287 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-5733
Practice Address - Country:US
Practice Address - Phone:276-298-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver