Healthcare Provider Details

I. General information

NPI: 1972228286
Provider Name (Legal Business Name): AGATA M ZEGLEN MS,APRN,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E WILLOW AVE
WHEATON IL
60187-5476
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-1221
  • Fax: 630-348-3045
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.026078
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0410398703
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: