Basic Information
| Provider Information | |||||||||
| NPI: | 1376516781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZURAT | ||||||||
| FirstName: | KIM | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 PORTLAND AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859225550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1445 PORTLAND AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859225550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 300954 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 01951133 | 05 | NY | MEDICAID |