Healthcare Provider Details

I. General information

NPI: 1477991651
Provider Name (Legal Business Name): NICOLE CHERIE ZUNIGA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 LYMAN RD
NORTH ROSE NY
14516-9611
US

IV. Provider business mailing address

10666 LYMAN RD
NORTH ROSE NY
14516-9611
US

V. Phone/Fax

Practice location:
  • Phone: 585-354-8004
  • Fax:
Mailing address:
  • Phone: 585-354-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number3041651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: