Provider Demographics
NPI:1164230082
Name:CHURCHWELL, ZANDREL LYNN
Entity type:Individual
Prefix:
First Name:ZANDREL
Middle Name:LYNN
Last Name:CHURCHWELL
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 1:11935 W DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-4303
Mailing Address - Country:US
Mailing Address - Phone:623-329-5935
Mailing Address - Fax:
Practice Address - Street 1:11935 W DAHLIA DR
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-4303
Practice Address - Country:US
Practice Address - Phone:623-329-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222867376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide