Provider Demographics
NPI:1710103924
Name:ZELLMER, NANCY JAYNE (GNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JAYNE
Last Name:ZELLMER
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JAYNE
Other - Last Name:CERVONE-ZELLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:3340 PROVIDENCE DR STE 358
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4627
Mailing Address - Country:US
Mailing Address - Phone:907-261-2880
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR STE 358
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-261-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKQ43074Medicare UPIN