Basic Information
| Provider Information | |||||||||
| NPI: | 1669628822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMBONI | ||||||||
| FirstName: | ANGELINA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5579 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977085579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417066623 | ||||||||
| FaxNumber: | 5415266626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 W MCKINNEY BUTTE RD | ||||||||
| Address2: | |||||||||
| City: | SISTERS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977593129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415266623 | ||||||||
| FaxNumber: | 5415163853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 814786 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 201150051NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.