=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750317699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN ZUMPANO NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 BROOKLEY RD
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13441-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-334-7100
-----------------------------------------------------
Fax | 315-334-7171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 CORTLAND LN
-----------------------------------------------------
City | WHITESBORO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13492-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-768-4384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F301126
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------