Provider Demographics
NPI:1215758487
Name:ZUMWALT, MARIE ADELLA
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ADELLA
Last Name:ZUMWALT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7076 ROAD 55F
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-7771
Mailing Address - Country:US
Mailing Address - Phone:307-532-6600
Mailing Address - Fax:
Practice Address - Street 1:2723 CHRISTENSEN RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-9662
Practice Address - Country:US
Practice Address - Phone:747-204-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY27180207Q00000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine