MEDICARE: ELLEN ORMOND ZUMMO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	9327	CT
2	363L00000X	Nurse Practitioner	9327	CT

General Provider Information

NPI Number	:	1336741719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ORMOND ZUMMO APRN

Provider Business Mailing Address
First Line	:	1 EVERGREEN AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2717
Country	:	US
Telephone Number	:	203-376-0220
Fax Number	:	203-651-1698

Provider Business Practice Location Address
First Line	:	1 EVERGREEN AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2717
Country	:	US
Telephone Number	:	203-376-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	05/07/2024

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