Healthcare Provider Details

I. General information

NPI: 1467855791
Provider Name (Legal Business Name): MARIE ZELHART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 REMINGTON BLVD 200
BOLINGBROOK IL
60440-5114
US

IV. Provider business mailing address

1000 REMINGTON BLVD 200
BOLINGBROOK IL
60440-5114
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-7755
  • Fax: 630-856-9933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.011868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: