Healthcare Provider Details

I. General information

NPI: 1730357377
Provider Name (Legal Business Name): KAREN ZOLLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BLACK COAL DR.
FORT WASHAKIE WY
82514
US

IV. Provider business mailing address

PO BOX 128
FORT WASHAKIE WY
82514-0128
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-7300
  • Fax: 307-322-1503
Mailing address:
  • Phone: 307-322-7300
  • Fax: 307-322-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30534.1168
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: