Healthcare Provider Details

I. General information

NPI: 1114273786
Provider Name (Legal Business Name): ANDREA EDWARDS ZUCKERMAN APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 300
NAPERVILLE IL
60563-8497
US

IV. Provider business mailing address

1755 PARK ST STE 300
NAPERVILLE IL
60563-8497
US

V. Phone/Fax

Practice location:
  • Phone: 630-983-8920
  • Fax: 630-983-4839
Mailing address:
  • Phone: 630-983-8920
  • Fax: 630-983-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209009530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: