Individual
MRS. MARY KATHRYN REEP ZICARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34011 US HIGHWAY 280, CHILDERSBURG, AL 35044-2128
(256) 378-3313
(256) 378-3315
Mailing address
PO BOX 349, 34011 HWY 280 EAST, CHILDERSBURG, AL 35044-0349
(256) 378-3313
(256) 378-3315
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-036663
AL
363LF0000X
Family Nurse Practitioner
Primary
1-036663
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021507842
MEDICARE PTAN
AL
05
—
125065
—
AL
Enumeration date
09/16/2009
Last updated
01/03/2012
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