Healthcare Provider Details

I. General information

NPI: 1861070161
Provider Name (Legal Business Name): JANICE ZACHMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N KNOXVILLE AVE STE 208
PEORIA IL
61614-5021
US

IV. Provider business mailing address

213 FAIROAKS CT
BARTONVILLE IL
61607-1862
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4908
  • Fax:
Mailing address:
  • Phone: 309-966-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.021065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: