1093928418 NPI number — MRS. KELIN BARBARA ZOELLNER PA-C

Table of content: MRS. KELIN BARBARA ZOELLNER PA-C (NPI 1093928418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093928418 NPI number — MRS. KELIN BARBARA ZOELLNER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOELLNER
Provider First Name:
KELIN
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
MRS.
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:
O'DONNELL
Provider Other First Name:
KELIN
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093928418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDSBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-768-3333
Provider Business Mailing Address Fax Number:
608-768-3335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-768-3333
Provider Business Practice Location Address Fax Number:
608-768-3335
Provider Enumeration Date:
05/08/2007

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: 363AM0700X , with the licence number:  2689-23 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 2689 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 61140 . This is a "DEAN HEALTH INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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