Provider Demographics
NPI:1467171322
Name:NZOMO, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NZOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 KING JAMES CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4744
Mailing Address - Country:US
Mailing Address - Phone:302-983-2895
Mailing Address - Fax:
Practice Address - Street 1:1332 KING JAMES CT
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4744
Practice Address - Country:US
Practice Address - Phone:302-983-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-10-18
Deactivation Date:2022-10-05
Deactivation Code:
Reactivation Date:2022-10-18
Provider Licenses
StateLicense IDTaxonomies
DE000044504363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology