Healthcare Provider Details

I. General information

NPI: 1881055630
Provider Name (Legal Business Name): SUSAN ZUMERGRAD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN SHAFFSTALL FNP

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W US HIGHWAY 24
WOODLAND PARK CO
80863-8975
US

IV. Provider business mailing address

2 S CASCADE AVE STE 140
COLORADO SPRINGS CO
80903-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1133
  • Fax:
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992197-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: