Healthcare Provider Details

I. General information

NPI: 1407525843
Provider Name (Legal Business Name): MATTHEW MICHAEL ZUNIGA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 UNIVERSITY AVE NE
FRIDLEY MN
55432-1847
US

IV. Provider business mailing address

4200 DAHLBERG DR STE 300
GOLDEN VALLEY MN
55422-4841
US

V. Phone/Fax

Practice location:
  • Phone: 763-786-9543
  • Fax: 763-786-3320
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8506
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: