Provider Demographics
NPI:1104580075
Name:ZUNKER, NICOLE D (RN,APNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:ZUNKER
Suffix:
Gender:F
Credentials:RN,APNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DINA
Other - Last Name:JESPERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:933 WAUBE LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5521
Practice Address - Country:US
Practice Address - Phone:920-548-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11518-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06210390OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS