Provider Demographics
NPI:1184860629
Name:ZEMAN, THERESA MARY (GNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:ZEMAN
Suffix:
Gender:F
Credentials:GNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30790 ZEPHYR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-4211
Mailing Address - Country:US
Mailing Address - Phone:507-330-2151
Mailing Address - Fax:
Practice Address - Street 1:30790 ZEPHYR VALLEY LN
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-4211
Practice Address - Country:US
Practice Address - Phone:507-330-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR112785-6363L00000X
MNR1127856363LG0600X
MNCNP0410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500006410Medicare PIN
MNS36534Medicare UPIN