Healthcare Provider Details

I. General information

NPI: 1386199503
Provider Name (Legal Business Name): MRS. MARIA ZELTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SPRING LN
PHILA PA
19128-3918
US

IV. Provider business mailing address

475 SPRING LN
PHILADELPHIA PA
19128-3918
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-5353
  • Fax:
Mailing address:
  • Phone: 214-482-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number286474L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: