Healthcare Provider Details

I. General information

NPI: 1457663585
Provider Name (Legal Business Name): LISA ZOLA MS, MSN, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 OGDEN AVE #104
LISLE IL
60532-1691
US

IV. Provider business mailing address

PO BOX 5217
WHEATON IL
60189-5217
US

V. Phone/Fax

Practice location:
  • Phone: 203-427-5555
  • Fax:
Mailing address:
  • Phone: 203-427-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.010335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: