Provider Demographics
NPI:1457014300
Name:ZAMOR, WISLISE NADEGE (NP)
Entity Type:Individual
Prefix:
First Name:WISLISE
Middle Name:NADEGE
Last Name:ZAMOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7724
Mailing Address - Country:US
Mailing Address - Phone:707-330-3982
Mailing Address - Fax:
Practice Address - Street 1:813 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7724
Practice Address - Country:US
Practice Address - Phone:707-330-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF02210913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily