Healthcare Provider Details

I. General information

NPI: 1184860629
Provider Name (Legal Business Name): THERESA MARY ZEMAN GNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30790 ZEPHYR VALLEY LN
RUSHFORD MN
55971-4211
US

IV. Provider business mailing address

30790 ZEPHYR VALLEY LN
RUSHFORD MN
55971-4211
US

V. Phone/Fax

Practice location:
  • Phone: 507-330-2151
  • Fax:
Mailing address:
  • Phone: 507-330-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR112785-6
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR1127856
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP0410
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: