Provider Demographics
NPI:1063963619
Name:JESKO, ZACHARY LAWRENCE (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:LAWRENCE
Last Name:JESKO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10548 N 100 W
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-9713
Mailing Address - Country:US
Mailing Address - Phone:219-510-2515
Mailing Address - Fax:862-298-0610
Practice Address - Street 1:221 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-8377
Practice Address - Country:US
Practice Address - Phone:219-987-7005
Practice Address - Fax:862-298-0610
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163653A163WC0200X
INF0916896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine