Provider Demographics
NPI:1154314854
Name:ZUKOWSKI, NANCY L (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:ZUKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:STROUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-9997
Practice Address - Street 1:3401 MAGNOLIA CV
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2375
Practice Address - Country:US
Practice Address - Phone:318-325-6311
Practice Address - Fax:318-361-9805
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD13775R2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432946Medicaid
LA1432946Medicaid