MEDICARE: KELLY ZIELINSKI-INTHANAMITH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	COA11819NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225334667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ZIELINSKI-INTHANAMITH NP

Provider Business Mailing Address
First Line	:	1421S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7413
Country	:	US
Telephone Number	:	419-725-6290
Fax Number	:	419-725-6287

Provider Business Practice Location Address
First Line	:	1421S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7413
Country	:	US
Telephone Number	:	419-725-6290
Fax Number	:	419-725-6287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	12/22/2015

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