Healthcare Provider Details

I. General information

NPI: 1083986988
Provider Name (Legal Business Name): NANCY L ZUKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 36TH ST SE
WYOMING MI
49548-2339
US

IV. Provider business mailing address

585 JEWETT RD
MASON MI
48854-8729
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-4580
  • Fax: 616-247-4590
Mailing address:
  • Phone: 517-676-5405
  • Fax: 517-676-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704146463
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: