Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD13775R | LA |
NPI | 1154314854 |
---|---|
Provider Name | Nancy L Zukowski |
First Address | Monroe, LA 71201-7319 |
Second Address | Monroe, LA 71203-2375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 15/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1432946 | (05) | LA |