Healthcare Provider Details

I. General information

NPI: 1295299659
Provider Name (Legal Business Name): ZALIKA OMOROSE' PRYSOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 SAVINA AVE
DAYTON OH
45415-1144
US

IV. Provider business mailing address

5508 SAVINA AVE
DAYTON OH
45415-1144
US

V. Phone/Fax

Practice location:
  • Phone: 937-304-5103
  • Fax:
Mailing address:
  • Phone: 937-304-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.023928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: