Healthcare Provider Details

I. General information

NPI: 1033183595
Provider Name (Legal Business Name): KATHLEEEN KAE ZAMBO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY KAE ZAMBO CNP

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24276 AIRPORT ROAD
EAGLE BUTTE SD
57625
US

IV. Provider business mailing address

39382 128TH ST
BATH SD
57427-5200
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-7724
  • Fax: 605-964-1110
Mailing address:
  • Phone: 605-226-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSD- RO17146
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: