Provider Demographics
NPI:1134271794
Name:ZOLLMAN, RACHEL ANN (PAC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:ZOLLMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 NORTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341
Mailing Address - Country:US
Mailing Address - Phone:616-942-9343
Mailing Address - Fax:616-942-2538
Practice Address - Street 1:6150 NORTHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341
Practice Address - Country:US
Practice Address - Phone:616-942-9343
Practice Address - Fax:616-942-2538
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004272207N00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN13100008Medicare PIN