Healthcare Provider Details

I. General information

NPI: 1649852294
Provider Name (Legal Business Name): NICOLE L ZINNECKER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E COZZA DR
SPOKANE WA
99208-6514
US

IV. Provider business mailing address

44 E COZZA DR
SPOKANE WA
99208-6514
US

V. Phone/Fax

Practice location:
  • Phone: 509-325-6800
  • Fax:
Mailing address:
  • Phone: 509-325-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN00163411
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: