Healthcare Provider Details

I. General information

NPI: 1689535072
Provider Name (Legal Business Name): NOEMI ZAMUDIO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOEMI ZARATE CNP

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 SPRING BROOK RD STE 108
ROCKFORD IL
61114-6700
US

IV. Provider business mailing address

814 ROBERT DR
WOODSTOCK IL
60098-2485
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-2750
  • Fax:
Mailing address:
  • Phone: 815-261-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: