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General NPI Number Information
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NPI Number | 1174292767
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Entity Type | Individual
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Provider Name | ZEYERUSALEM WOLDESILASSE
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 10385 OLD PLACERVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95827-2506
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Country | US
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Telephone | 916-448-1770
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Fax | 916-448-3015
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Provider Business Mailing Address
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Address Line | 5201 NECTAR CIR
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City | ELK GROVE
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State | CA
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Zip | 95757-4333
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Country | US
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Telephone | 602-570-4281
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP95016910
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License Number State | CA
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