Provider Demographics
NPI:1376809590
Name:ZELLER, EMEM ASUQUO (APN NP-C)
Entity type:Individual
Prefix:
First Name:EMEM
Middle Name:ASUQUO
Last Name:ZELLER
Suffix:
Gender:F
Credentials:APN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHITE BRIDGE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1467
Mailing Address - Country:US
Mailing Address - Phone:615-352-3000
Mailing Address - Fax:615-352-6673
Practice Address - Street 1:28 WHITE BRIDGE RD STE 208
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1467
Practice Address - Country:US
Practice Address - Phone:615-352-3000
Practice Address - Fax:615-352-6673
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528686Medicaid
TN1528686Medicaid