Provider Demographics
NPI:1649250093
Name:ZULL, PATRICIA R (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:ZULL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2129
Mailing Address - Country:US
Mailing Address - Phone:269-345-6197
Mailing Address - Fax:269-345-9734
Practice Address - Street 1:2854 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2129
Practice Address - Country:US
Practice Address - Phone:269-345-6197
Practice Address - Fax:269-345-9734
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3015259Medicaid
MI1013089820OtherBCBSM - BRONSON
MI1649250093Medicaid
M74680022Medicare PIN