Healthcare Provider Details

I. General information

NPI: 1891164257
Provider Name (Legal Business Name): BRANDON NICOLAS ZUMBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 UNIVERSITY ST
PELLA IA
50219
US

IV. Provider business mailing address

200 11TH ST SW
WAVERLY IA
50677-2809
US

V. Phone/Fax

Practice location:
  • Phone: 319-327-0791
  • Fax:
Mailing address:
  • Phone: 319-327-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: