Provider Demographics
NPI:1215005830
Name:ZELSDORF, KENNETH ERIC (NP)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ERIC
Last Name:ZELSDORF
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 BEECHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1557
Mailing Address - Country:US
Mailing Address - Phone:559-309-3875
Mailing Address - Fax:
Practice Address - Street 1:1560 W LACEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3581
Practice Address - Country:US
Practice Address - Phone:559-772-8285
Practice Address - Fax:559-772-8312
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 16481363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA181247Medicare PIN