Provider Demographics
NPI:1528049632
Name:ZAPF, CONNIE D (PA-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:ZAPF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W STROOP RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2041
Mailing Address - Country:US
Mailing Address - Phone:937-298-4709
Mailing Address - Fax:937-298-6062
Practice Address - Street 1:2400 W STROOP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2007
Practice Address - Country:US
Practice Address - Phone:937-298-4709
Practice Address - Fax:937-298-6062
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001397363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00011729OtherMEDICARE RAILROAD
OHP00011729OtherMEDICARE RAILROAD
OHPA16582Medicare PIN