Basic Information
| Provider Information | |||||||||
| NPI: | 1326609314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZALOCHA | ||||||||
| FirstName: | VANETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATTIS | ||||||||
| OtherFirstName: | VANETTE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 500 | ||||||||
| Address2: | |||||||||
| City: | ELLICOTTVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147310500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166999032 | ||||||||
| FaxNumber: | 7166999035 | ||||||||
| Practice Location | |||||||||
| Address1: | 6870 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130661031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156794367 | ||||||||
| FaxNumber: | 3156794368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2019 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 344570 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.