Healthcare Provider Details

I. General information

NPI: 1588901946
Provider Name (Legal Business Name): MARY NONGNDEH ZELIO CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 ROUTE 108 STE A
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9814 PHEASANT RUN CT
LAUREL MD
20708-3192
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax: 410-740-8237
Mailing address:
  • Phone: 240-476-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number204271
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: