Healthcare Provider Details

I. General information

NPI: 1245047034
Provider Name (Legal Business Name): RENEE LYNN ZOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CUMMINGS RD
GREENE NY
13778-2517
US

IV. Provider business mailing address

607 CUMMINGS RD
GREENE NY
13778-2517
US

V. Phone/Fax

Practice location:
  • Phone: 607-591-4362
  • Fax:
Mailing address:
  • Phone: 607-591-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number339664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: