Healthcare Provider Details

I. General information

NPI: 1952932709
Provider Name (Legal Business Name): BENJAMIN ROBERT ZUMWALT FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

IV. Provider business mailing address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

V. Phone/Fax

Practice location:
  • Phone: 707-547-2222
  • Fax:
Mailing address:
  • Phone: 707-547-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: