Healthcare Provider Details

I. General information

NPI: 1275049744
Provider Name (Legal Business Name): AMBER NICOLE ZOOT CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 NE 129TH ST
VANCOUVER WA
98686-3212
US

IV. Provider business mailing address

206 NE 126TH AVE APT E59
VANCOUVER WA
98684-1809
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-0776
  • Fax:
Mailing address:
  • Phone: 360-852-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number60603906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: