Provider Demographics
NPI:1982295929
Name:ZACK, DAISY
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:ZACK
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 1:279 CASTOR RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-8751
Mailing Address - Country:US
Mailing Address - Phone:419-543-3231
Mailing Address - Fax:
Practice Address - Street 1:279 CASTOR RD APT 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-8751
Practice Address - Country:US
Practice Address - Phone:419-543-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health