Individual
JEENU MARY ZACHARIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 CEDAR ST, TMP3, YALE UNIVERSITY, DEPARTMENT OF ANESTHESIOLOGY, NEW HAVEN, CT 06520-8051
(203) 737-1549
(203) 785-6664
Mailing address
25 BROADMEADOW RD, WALLINGFORD, CT 06492-6045
(203) 300-0045
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
078356
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
6841
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078356
RN LICENSE
CT
01
—
6841
APRN LICENSE
CT
Enumeration date
10/20/2016
Last updated
12/22/2016
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