Healthcare Provider Details

I. General information

NPI: 1689263444
Provider Name (Legal Business Name): JENNIFER M ZENK APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 S IL ROUTE 47
HUNTLEY IL
60142-9613
US

IV. Provider business mailing address

11650 S IL ROUTE 47
HUNTLEY IL
60142-9613
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7300
  • Fax: 847-668-2647
Mailing address:
  • Phone: 847-802-7300
  • Fax: 847-668-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022177
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022177
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: