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General NPI Number Information
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NPI Number | 1578304366
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Entity Type | Individual
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Provider Name | ZERUYA GADDAM APRN
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 430 E 162ND ST # 487
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-960-4280
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Fax | 708-816-0023
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Provider Business Mailing Address
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Address Line | 430 E 162ND ST # 487
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-960-4280
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Fax | 708-816-0023
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028493
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License Number State | IL
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