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General NPI Number Information
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NPI Number | 1467841338
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Entity Type | Individual
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Provider Name | MARY K ZIELKE FNP
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Gender | Female
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 1600 W WALNUT ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1136
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Country | US
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Telephone | 217-245-7275
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19639
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9639
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Country | US
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Telephone | 217-545-7578
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209012398
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License Number State | IL
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