Basic Information
| Provider Information | |||||||||
| NPI: | 1023352721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIENTEK | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 781 GRAND CASINO BLVD | ||||||||
| Address2: | CITIZEN POTAWATOMI NATION HEALTH SERVICES | ||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748041005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059645770 | ||||||||
| FaxNumber: | 4059645788 | ||||||||
| Practice Location | |||||||||
| Address1: | 781 GRAND CASINO BLVD | ||||||||
| Address2: | CITIZEN POTAWATOMI NATION HEALTH SERVICES | ||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748041005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059645770 | ||||||||
| FaxNumber: | 4059645788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | RO42152 | OK | Y | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.