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General NPI Number Information
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NPI Number | 1912704321
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Entity Type | Individual
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Provider Name | STEPHANIE ZACHEMSKI
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 2179 W ALGONQUIN RD
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City | ALGONQUIN
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State | IL
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Zip | 60102
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Country | US
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Telephone | 847-381-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 W ALGONQUIN RD
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City | ALGONQUIN
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State | IL
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Zip | 60102-9400
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 011149
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License Number State | IL
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