Healthcare Provider Details

I. General information

NPI: 1093268427
Provider Name (Legal Business Name): ALLISON ZITRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 W WINNEMAC AVE APT 2E
CHICAGO IL
60640-2800
US

IV. Provider business mailing address

1463 W WINNEMAC AVE APT 2E
CHICAGO IL
60640-2800
US

V. Phone/Fax

Practice location:
  • Phone: 586-201-0815
  • Fax:
Mailing address:
  • Phone: 586-201-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209104067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number209014067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: