Provider Demographics
NPI:1881938330
Name:ZANVETTOR, GINA J (LPN)
Entity type:Individual
Prefix:MISS
First Name:GINA
Middle Name:J
Last Name:ZANVETTOR
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 1:64 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2614
Mailing Address - Country:US
Mailing Address - Phone:413-207-2042
Mailing Address - Fax:
Practice Address - Street 1:64 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-2614
Practice Address - Country:US
Practice Address - Phone:413-207-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89667164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100038914535Medicaid