Healthcare Provider Details

I. General information

NPI: 1942773056
Provider Name (Legal Business Name): NINA MICHELLE ZEGLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIO VISTA DR
FALLON NV
89406-5463
US

IV. Provider business mailing address

680 S ROCK BLVD
RENO NV
89502-4113
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3634
  • Fax:
Mailing address:
  • Phone: 775-329-6300
  • Fax: 775-348-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2264
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: