Healthcare Provider Details

I. General information

NPI: 1083472906
Provider Name (Legal Business Name): NICHOLE ESTELA ZUMAETA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7-11 S BROADWAY
WHITE PLAINS NY
10601-3531
US

IV. Provider business mailing address

19 OLD MAMARONECK RD APT 3J
WHITE PLAINS NY
10605-1729
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-4900
  • Fax:
Mailing address:
  • Phone: 914-512-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number735811
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: