Basic Information
| Provider Information | |||||||||
| NPI: | 1932566155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISNIC | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 STURGIS ROAD | ||||||||
| Address2: | NAVAL HOSPITAL TWNETYNINE PALMS | ||||||||
| City: | TWENTYNINE PALMS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922788275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608302117 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1145 STURGIS ROAD | ||||||||
| Address2: | NAVAL HOSPITAL TWENTYNINE PALMS | ||||||||
| City: | TWENTYNINE PALMS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922788275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608302117 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 20345 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN2305360 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 006283 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 95001546 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.