Basic Information
| Provider Information | |||||||||
| NPI: | 1295979359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZABAK | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | GNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24165 DETROIT RD | ||||||||
| Address2: | INFINITY NP | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441451516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402503560 | ||||||||
| FaxNumber: | 4406171815 | ||||||||
| Practice Location | |||||||||
| Address1: | 24165 DETROIT RD | ||||||||
| Address2: | INFINITY NP | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441451516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402503560 | ||||||||
| FaxNumber: | 4406171815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 04/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | NP07216 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 2376816 | 05 | OH | MEDICAID |