Healthcare Provider Details

I. General information

NPI: 1962177139
Provider Name (Legal Business Name): CHRISTOPHER JOHN ZOLKOWSKI ADN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MILLINGTON DR
HARTLAND WI
53029-1641
US

IV. Provider business mailing address

345 MILLINGTON DR
HARTLAND WI
53029-1641
US

V. Phone/Fax

Practice location:
  • Phone: 920-284-3982
  • Fax:
Mailing address:
  • Phone: 920-284-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: