Healthcare Provider Details

I. General information

NPI: 1700221892
Provider Name (Legal Business Name): CARLA LYNN ZAVALA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD
NEW LENOX IL
60451-9524
US

IV. Provider business mailing address

1890 SILVER CROSS BLVD
NEW LENOX IL
60451-9524
US

V. Phone/Fax

Practice location:
  • Phone: 815-723-4387
  • Fax: 815-723-4634
Mailing address:
  • Phone: 815-723-4387
  • Fax: 815-723-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277.000885
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209010409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: