Healthcare Provider Details

I. General information

NPI: 1366405086
Provider Name (Legal Business Name): PAULA A ZUCCARO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER ROAD
KYLE SD
57752
US

IV. Provider business mailing address

530 DE MOSS ST
LORDSBURG NM
88045-2617
US

V. Phone/Fax

Practice location:
  • Phone: 605-455-2451
  • Fax:
Mailing address:
  • Phone: 575-542-2307
  • Fax: 575-542-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberSD-RN 023016
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-03587
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000107
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: