Healthcare Provider Details

I. General information

NPI: 1174332720
Provider Name (Legal Business Name): ZACHARY C KOESTER DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OAKMONT LN
WESTMONT IL
60559-5551
US

IV. Provider business mailing address

750 OAKMONT LN
WESTMONT IL
60559-5551
US

V. Phone/Fax

Practice location:
  • Phone: 877-552-6672
  • Fax: 224-306-1878
Mailing address:
  • Phone: 877-552-6672
  • Fax: 224-306-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.031255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: