Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 697023 | TX |
NPI | 1144652686 |
---|---|
Provider Name | Jennifer June Zachary |
First Address | Sunrise, FL 33323-2853 |
Second Address | Lewisville, TX 75057-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2013 |
Last Update Date | 07/08/2013 |