Provider Demographics
NPI:1699735126
Name:ZELLER, EMILIA (CRNA)
Entity type:Individual
Prefix:MS
First Name:EMILIA
Middle Name:
Last Name:ZELLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:
Other - Last Name:ZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2112 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4209
Mailing Address - Country:US
Mailing Address - Phone:817-791-7067
Mailing Address - Fax:817-766-7027
Practice Address - Street 1:1021 HOLDEN ST
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4937
Practice Address - Country:US
Practice Address - Phone:254-897-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX459582367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109916012Medicaid
TXP01446810OtherRR
TX8788UGOtherBCBS
TX00C17UOtherBCBSTX
TX00C17UOtherBCBSTX
TX8788UGOtherBCBS
TXP01446810OtherRR