Provider Demographics
NPI:1043562572
Name:ZELLER, ANA ELISABETH (RD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ELISABETH
Last Name:ZELLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 S CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5309
Mailing Address - Country:US
Mailing Address - Phone:910-622-5083
Mailing Address - Fax:
Practice Address - Street 1:2103 S CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5309
Practice Address - Country:US
Practice Address - Phone:910-622-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1100738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered