Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704190911 | MI |
NPI | 1013212638 |
---|---|
Provider Name | Teresea Ann Zarza |
First Address | Livonia, MI 48154-5010 |
Second Address | Southfield, MI 48075-4818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2011 |
Last Update Date | 20/05/2016 |