Healthcare Provider Details

I. General information

NPI: 1730809054
Provider Name (Legal Business Name): FRANK DAVID ZUCCALA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 13TH ST W
HAVRE MT
59501-5145
US

IV. Provider business mailing address

PO BOX 7751
HAVRE MT
59501-7751
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-3591
  • Fax:
Mailing address:
  • Phone: 513-657-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-197381
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: