Healthcare Provider Details

I. General information

NPI: 1821050196
Provider Name (Legal Business Name): VICKIE MARIE ZELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DIVISION ST
PRESCOTT AZ
86301-1618
US

IV. Provider business mailing address

11301 N T QUARTER CIR
PRESCOTT VALLEY AZ
86315
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4818
  • Fax: 928-445-4837
Mailing address:
  • Phone: 928-848-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: