1467420349 NPI number — MRS. MARY LYNN ZAZZI FOSTER FNP

Table of content: MRS. MARY LYNN ZAZZI FOSTER FNP (NPI 1467420349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467420349 NPI number — MRS. MARY LYNN ZAZZI FOSTER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
MARY LYNN
Provider Middle Name:
ZAZZI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTER
Provider Other First Name:
MARILYN
Provider Other Middle Name:
Z.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467420349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 HOLSTON TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBER CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24290-6905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-386-1312
Provider Business Mailing Address Fax Number:
276-386-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 BEECH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GATE CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24251-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-386-1312
Provider Business Practice Location Address Fax Number:
276-386-2116
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024164144 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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