Healthcare Provider Details

I. General information

NPI: 1336741719
Provider Name (Legal Business Name): ELLEN ORMOND ZUMMO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EVERGREEN AVE
HAMDEN CT
06518-2717
US

IV. Provider business mailing address

1 EVERGREEN AVE
HAMDEN CT
06518-2717
US

V. Phone/Fax

Practice location:
  • Phone: 203-376-0220
  • Fax:
Mailing address:
  • Phone: 203-376-0220
  • Fax: 203-651-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9327
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9327
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: