Provider Demographics
NPI:1548574585
Name:ZUMBACH, ANDREW LOUIS (RN, NP-C)
Entity Type:Individual
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First Name:ANDREW
Middle Name:LOUIS
Last Name:ZUMBACH
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Gender:M
Credentials:RN, NP-C
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Mailing Address - Street 1:255 SMITH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2572
Mailing Address - Country:US
Mailing Address - Phone:651-241-5000
Mailing Address - Fax:651-241-7678
Practice Address - Street 1:255 SMITH AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2572
Practice Address - Country:US
Practice Address - Phone:651-241-5000
Practice Address - Fax:651-241-7678
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR 12970-6363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 129701-6OtherNURSING LIC.