Basic Information
| Provider Information | |||||||||
| NPI: | 1588700702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZINKEN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, RN, CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHRISTIANSON | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21370 JOHN MILLESS DR | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | ROGERS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553749449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7634282288 | ||||||||
| FaxNumber: | 7634282132 | ||||||||
| Practice Location | |||||||||
| Address1: | 21370 JOHN MILLESS DR | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | ROGERS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553749449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7634282288 | ||||||||
| FaxNumber: | 7634282132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R101756-8 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.