Healthcare Provider Details

I. General information

NPI: 1174607568
Provider Name (Legal Business Name): ELLEN M ZINDEL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/29/2026
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

IV. Provider business mailing address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-6100
  • Fax: 833-784-5326
Mailing address:
  • Phone: 217-422-6100
  • Fax: 833-784-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-003617
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number209-003617
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: