Provider Demographics
NPI:1609612019
Name:DETH, ZINNIA
Entity type:Individual
Prefix:
First Name:ZINNIA
Middle Name:
Last Name:DETH
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 1:40 STURGIS ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4822
Mailing Address - Country:US
Mailing Address - Phone:978-427-3471
Mailing Address - Fax:
Practice Address - Street 1:40 STURGIS ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4822
Practice Address - Country:US
Practice Address - Phone:978-427-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10001632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse