Healthcare Provider Details

I. General information

NPI: 1154314854
Provider Name (Legal Business Name): NANCY L ZUKOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY STROUP

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MAGNOLIA CV
MONROE LA
71203-2375
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-6311
  • Fax: 318-361-9805
Mailing address:
  • Phone:
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD13775R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13775R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: