Provider Demographics
NPI:1295979359
Name:ZABAK, KATHRYN MARY (GNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:ZABAK
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24165 DETROIT RD
Mailing Address - Street 2:INFINITY NP
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1516
Mailing Address - Country:US
Mailing Address - Phone:440-250-3560
Mailing Address - Fax:440-617-1815
Practice Address - Street 1:24165 DETROIT RD
Practice Address - Street 2:INFINITY NP
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1516
Practice Address - Country:US
Practice Address - Phone:440-250-3560
Practice Address - Fax:440-617-1815
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07216363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2376816Medicaid
OH2376816Medicaid