Healthcare Provider Details

I. General information

NPI: 1619043759
Provider Name (Legal Business Name): NANCY CAROL ZUPAN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH AVE NE STE A
DEER RIVER MN
56636-8795
US

IV. Provider business mailing address

400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8275
  • Fax:
Mailing address:
  • Phone: 218-786-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0929217
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: