1871725333 NPI number — MRS. DEBORAH KATHRYN ZONGO APRN, CNP

Table of content: MRS. DEBORAH KATHRYN ZONGO APRN, CNP (NPI 1871725333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871725333 NPI number — MRS. DEBORAH KATHRYN ZONGO APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZONGO
Provider First Name:
DEBORAH
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAHNKE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP- BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871725333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2386 CLOUD DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55449-5408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-325-8402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 109TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-6794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-726-9153
Provider Business Practice Location Address Fax Number:
833-972-1581
Provider Enumeration Date:
08/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R160750-9 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2705 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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