Provider Demographics
NPI:1326609314
Name:ZALOCHA, VANETTE (NP)
Entity Type:Individual
Prefix:
First Name:VANETTE
Middle Name:
Last Name:ZALOCHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANETTE
Other - Middle Name:
Other - Last Name:MATTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:716-699-9035
Practice Address - Street 1:6870 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1031
Practice Address - Country:US
Practice Address - Phone:315-679-4367
Practice Address - Fax:315-679-4368
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily