Healthcare Provider Details

I. General information

NPI: 1770039380
Provider Name (Legal Business Name): LARADO ZERGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 N 2ND ST
LANDER WY
82520-9731
US

IV. Provider business mailing address

2164 N 2ND ST
LANDER WY
82520-9731
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-2114
  • Fax: 307-263-7536
Mailing address:
  • Phone: 307-438-2211
  • Fax: 307-263-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number22024
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number22024
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: