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General NPI Number Information
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NPI Number | 1003639865
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Entity Type | Individual
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Provider Name | ROBERT ZICKAFOOSE FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 701 MADISON AVE
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City | MADISON
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State | WV
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Zip | 25130-1669
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Country | US
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Telephone | 304-369-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 2172 UPPER CRAWLEY CREEK RD
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City | CHAPMANVILLE
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State | WV
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Zip | 25508-7178
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Country | US
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Telephone | 304-953-3974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 121153
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License Number State | WV
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