Provider Demographics
NPI:1871939454
Name:ZIZEK, TERRI LEE (RN)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LEE
Last Name:ZIZEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-0632
Mailing Address - Country:US
Mailing Address - Phone:614-843-0795
Mailing Address - Fax:
Practice Address - Street 1:82 THORNHILL DRIVE
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-0632
Practice Address - Country:US
Practice Address - Phone:614-843-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN374096163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse