Healthcare Provider Details

I. General information

NPI: 1093024200
Provider Name (Legal Business Name): DIANE MARIE ZUELKE ANP-FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE 703
MORRIS IL
60450
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-8000
  • Fax: 815-705-1712
Mailing address:
  • Phone: 815-705-5605
  • Fax: 815-941-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: