Healthcare Provider Details

I. General information

NPI: 1366896268
Provider Name (Legal Business Name): NURSE PRACTITIONER ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2016
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 Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP0410
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP0410
License Number StateMN

VIII. Authorized Official

Name: THERESA M ZEMAN
Title or Position: CEO
Credential: PMHNP-BC, GNP-BC
Phone: 507-330-2151