Healthcare Provider Details

I. General information

NPI: 1245756113
Provider Name (Legal Business Name): ELIZABETH MARIE ZUELKE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

V. Phone/Fax

Practice location:
  • Phone: 815-530-5629
  • Fax:
Mailing address:
  • Phone: 815-530-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.015278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: