Healthcare Provider Details

I. General information

NPI: 1518194091
Provider Name (Legal Business Name): MICHELLE PETERS ZAPPAS DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 149TH ST
BRONX NY
10451-5602
US

IV. Provider business mailing address

5205 MELROSE AVE
LOS ANGELES CA
90038-3144
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-4300
  • Fax:
Mailing address:
  • Phone: 323-653-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95002345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335854-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: