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General NPI Number Information
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NPI Number | 1003837998
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Entity Type | Individual
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Provider Name | ETEL ZEVELEVA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 107 CLYDE AVE
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City | EVANSTON
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State | IL
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Zip | 60202-4001
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Country | US
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Telephone | 847-869-7389
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Fax |
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Provider Business Mailing Address
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Address Line | 7307 N EAST PRAIRIE RD
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1009
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Country | US
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Telephone | 847-677-5983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | IL
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