Provider Demographics
NPI:1033183595
Name:ZAMBO, KATHLEEEN KAE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEEN
Middle Name:KAE
Last Name:ZAMBO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:KAE
Other - Last Name:ZAMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:39382 128TH ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:SD
Mailing Address - Zip Code:57427-5200
Mailing Address - Country:US
Mailing Address - Phone:605-226-0184
Mailing Address - Fax:
Practice Address - Street 1:24276 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625
Practice Address - Country:US
Practice Address - Phone:605-964-7724
Practice Address - Fax:605-964-1110
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD- RO17146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily