Basic Information
| Provider Information | |||||||||
| NPI: | 1750025003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLLER | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | DNAP, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 BROOK LN | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178168815 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 S FRONT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171012010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177823131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2022 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 237735 | SC | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WC0200X | RN674404 | PA | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.