Healthcare Provider Details

I. General information

NPI: 1649561663
Provider Name (Legal Business Name): ELISE ZINK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 PACKARD AVE SUITE #100
MARYSVILLE CA
95901-7118
US

IV. Provider business mailing address

2249 12TH AVE
SACRAMENTO CA
95818-4329
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-6366
  • Fax: 530-749-6397
Mailing address:
  • Phone: 530-749-6329
  • Fax: 530-749-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number790616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: