1821280181 NPI number — MS. HOLLY NICOLE ZELLER PA-C

Table of content: MS. HOLLY NICOLE ZELLER PA-C (NPI 1821280181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821280181 NPI number — MS. HOLLY NICOLE ZELLER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZELLER
Provider First Name:
HOLLY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821280181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 E WATERLOO RD
Provider Second Line Business Mailing Address:
STE 313
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44312-3856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-208-2720
Provider Business Mailing Address Fax Number:
330-208-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 S SMITH RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-9270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-208-2720
Provider Business Practice Location Address Fax Number:
330-208-2721
Provider Enumeration Date:
08/10/2007

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: 363A00000X , with the licence number:  50.002645 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12161909 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0067603 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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