Provider Demographics
NPI:1063058204
Name:ARNESEN, ZIBA SHANNON
Entity type:Individual
Prefix:
First Name:ZIBA
Middle Name:SHANNON
Last Name:ARNESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3919
Mailing Address - Country:US
Mailing Address - Phone:810-969-4546
Mailing Address - Fax:810-969-4549
Practice Address - Street 1:1227 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3919
Practice Address - Country:US
Practice Address - Phone:810-969-4546
Practice Address - Fax:810-969-4549
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily