Provider Demographics
NPI:1134994122
Name:ZOLLER, STEPHANIE R (MSDD, MSN, RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:MSDD, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 LUCY CORR BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832
Mailing Address - Country:US
Mailing Address - Phone:804-481-1692
Mailing Address - Fax:804-717-6306
Practice Address - Street 1:6831 LUCY CORR BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2383
Practice Address - Country:US
Practice Address - Phone:804-717-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001257642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse