Healthcare Provider Details

I. General information

NPI: 1336408319
Provider Name (Legal Business Name): NICOLE ZEOLI VIVELO ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ZEOLI

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE M4-PFS
SEATTLE WA
98101-1000
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0420
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberSP012190
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430634
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60970565
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: