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General NPI Number Information
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NPI Number | 1154304558
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Entity Type | Individual
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Provider Name | LAURA J ZOELLNER MD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD #2207
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City | MERIDIAN
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State | ID
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Zip | 83642-6354
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Country | US
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Telephone | 208-288-0989
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Fax | 208-288-0976
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Provider Business Mailing Address
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Address Line | 520 S EAGLE RD SUITE 2207
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City | MERIDIAN
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State | ID
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Zip | 83642-6354
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Country | US
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Telephone | 208-288-0989
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Fax | 208-288-0976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M8106
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License Number State | ID
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