Provider Demographics
NPI:1760731814
Name:ZELLMER-WAM, KELLY I (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:I
Last Name:ZELLMER-WAM
Suffix:
Gender:F
Credentials:APRN, CNP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS: 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-3456
Mailing Address - Fax:651-254-9673
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:126-262-7800
Practice Address - Fax:612-262-7022
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCNP 1343363L00000X
MN1343363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500008073Medicare PIN