Healthcare Provider Details

I. General information

NPI: 1518802974
Provider Name (Legal Business Name): ZETAPUPPIS AND PINECONE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 WHIPCORD DR
WAXHAW NC
28173-2025
US

IV. Provider business mailing address

3013 WHIPCORD DR
WAXHAW NC
28173-2025
US

V. Phone/Fax

Practice location:
  • Phone: 262-501-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MIKHAIL RYBIN
Title or Position: VICE PRESIDENT
Credential: NP
Phone: 262-501-3738