Healthcare Provider Details

I. General information

NPI: 1518395573
Provider Name (Legal Business Name): ROBIN ROCHE ZOOK ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 TUNNEL RD
POTTSVILLE PA
17901-3875
US

IV. Provider business mailing address

8 E 34TH ST
READING PA
19606-3119
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-5455
  • Fax: 570-622-5493
Mailing address:
  • Phone: 610-781-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012378
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: