Provider Demographics
NPI:1831494293
Name:ZIKORUS, CAITHLEEN PATERSON (NP)
Entity Type:Individual
Prefix:
First Name:CAITHLEEN
Middle Name:PATERSON
Last Name:ZIKORUS
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:PO BOX 1955
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1955
Mailing Address - Country:US
Mailing Address - Phone:845-282-1723
Mailing Address - Fax:707-884-4625
Practice Address - Street 1:46900 OCEAN DR
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-9544
Practice Address - Country:US
Practice Address - Phone:707-884-4005
Practice Address - Fax:707-884-4625
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336535363LF0000X
CA95019942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily