Healthcare Provider Details

I. General information

NPI: 1104580075
Provider Name (Legal Business Name): NICOLE D ZUNKER RN,APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DINA JESPERSON RN

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WAUBE LN
GREEN BAY WI
54304-5521
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-548-9500
  • Fax:
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11518-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: