Healthcare Provider Details

I. General information

NPI: 1639100514
Provider Name (Legal Business Name): KERRY FITZGERALD ZEBOLD R.N., M.S.N., P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ #30
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4192
  • Fax: 773-880-3053
Mailing address:
  • Phone: 773-880-4192
  • Fax: 773-880-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-003528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: