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General NPI Number Information
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NPI Number | 1063963619
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Entity Type | Individual
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Provider Name | ZACHARY LAWRENCE JESKO FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 221 W DIVISION ST
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City | DEMOTTE
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State | IN
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Zip | 46310-8377
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Country | US
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Telephone | 219-987-7005
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Fax | 862-298-0610
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Provider Business Mailing Address
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Address Line | 10548 N 100 W
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City | WHEATFIELD
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State | IN
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Zip | 46392-9713
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Country | US
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Telephone | 219-510-2515
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Fax | 862-298-0610
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 28163653A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0916896
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License Number State | IN
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