Healthcare Provider Details

I. General information

NPI: 1942968250
Provider Name (Legal Business Name): ANDREA ZOELLNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 VIERSE DR
FARMINGTON MO
63640-1388
US

IV. Provider business mailing address

1664 RED BUD CT
PERRYVILLE MO
63775-1280
US

V. Phone/Fax

Practice location:
  • Phone: 573-517-8898
  • Fax:
Mailing address:
  • Phone: 573-517-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: