Individual
EBONIE MYAKEE ZOLLICOFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
N62W23334 SILVER SPRING DR, SUSSEX, WI 53089-3875
(262) 225-1163
Mailing address
N55W21268 LOGAN DR, MENOMONEE FALLS, WI 53051-6211
(262) 225-1163
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
159473
WI
363LF0000X
Family Nurse Practitioner
Primary
9919
WI
Other
Enumeration date
03/28/2015
Last updated
05/25/2020
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