Healthcare Provider Details

I. General information

NPI: 1407329980
Provider Name (Legal Business Name): ZOE PSANIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19657 S LA GRANGE RD
MOKENA IL
60448-9360
US

IV. Provider business mailing address

19657 S LA GRANGE RD
MOKENA IL
60448-9360
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-8232
  • Fax:
Mailing address:
  • Phone: 708-785-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: