MEDICARE: MRS. DONNA L ZOLLERS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	643868	TX

General Provider Information

NPI Number	:	1659542868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA L ZOLLERS NP

Provider Business Mailing Address
First Line	:	2200 HIGHWAY 365
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-5506
Country	:	US
Telephone Number	:	409-722-4321
Fax Number	:	409-729-2332

Provider Business Practice Location Address
First Line	:	2200 HIGHWAY 365
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-5506
Country	:	US
Telephone Number	:	409-722-4321
Fax Number	:	409-729-2332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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