Provider Demographics
NPI:1962876086
Name:ZAEBST, LARAE
Entity type:Individual
Prefix:
First Name:LARAE
Middle Name:
Last Name:ZAEBST
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 1:149 LAUREL LEAH
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6333
Mailing Address - Country:US
Mailing Address - Phone:810-338-1167
Mailing Address - Fax:
Practice Address - Street 1:149 LAUREL LEAH
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6333
Practice Address - Country:US
Practice Address - Phone:810-338-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703091827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse