Healthcare Provider Details

I. General information

NPI: 1174948301
Provider Name (Legal Business Name): THERESA ZUMBA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 FLORENCE AVE
EVANSTON IL
60202-1143
US

IV. Provider business mailing address

5715 N RICHMOND ST
CHICAGO IL
60659-4803
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-6144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.408744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: