Healthcare Provider Details

I. General information

NPI: 1427082353
Provider Name (Legal Business Name): ZENA VATMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZENA ALTER

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 E PUTNAM AVE
RIVERSIDE CT
06878-1522
US

IV. Provider business mailing address

1239 E PUTNAM AVE
RIVERSIDE CT
06878-1522
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 866-698-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002818
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: