Basic Information
| Provider Information | |||||||||
| NPI: | 1588901946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZELIO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | NONGNDEH | ||||||||
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| Credential: | CRNP-PMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9814 PHEASANT RUN CT | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207083192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404762185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9030 ROUTE 108 STE A | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107401901 | ||||||||
| FaxNumber: | 4107408237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2013 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 204271 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.