=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629099668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL ZEMZICKI FASO RN, MSN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1524 MCHENRY AVE STE 315 ROOM 37
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-557-6200
-----------------------------------------------------
Fax | 209-557-6235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4424 GOLD NUGGET CT
-----------------------------------------------------
City | SALIDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95368-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-543-7937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 305157
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------