Provider Demographics
NPI:1386785541
Name:ZUKOSKI, JERI L (CNM)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:L
Last Name:ZUKOSKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 LEACH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1336
Mailing Address - Country:US
Mailing Address - Phone:510-530-3374
Mailing Address - Fax:510-649-0219
Practice Address - Street 1:2107 DWIGHT WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2028
Practice Address - Country:US
Practice Address - Phone:510-530-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW006260Medicaid