Healthcare Provider Details

I. General information

NPI: 1548574585
Provider Name (Legal Business Name): ANDREW LOUIS ZUMBACH RN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SMITH AVE N SUITE 100
SAINT PAUL MN
55102-2572
US

IV. Provider business mailing address

255 SMITH AVE N SUITE 100
SAINT PAUL MN
55102-2572
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5000
  • Fax: 651-241-7678
Mailing address:
  • Phone: 651-241-5000
  • Fax: 651-241-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 12970-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: