MEDICARE: MS. JULIE A ZAISER 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		IL

General Provider Information

NPI Number	:	1972580660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE A ZAISER NP

Provider Business Mailing Address
First Line	:	1601 PARKVIEW AVE
Second Line	:	CREDENTIALING S200
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1822
Country	:	US
Telephone Number	:	815-395-5851
Fax Number	:	815-395-5644

Provider Business Practice Location Address
First Line	:	2170 PEARL ST
Second Line	:	UNIVERSITY PRIMARY CARE CLINIC @ BELVIDERE
City	:	BELVIDERE
State	:	IL
Zip	:	61008-6020
Country	:	US
Telephone Number	:	815-547-5461
Fax Number	:	815-395-5644

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	09/10/2007

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