Provider Demographics
NPI:1093556409
Name:ZAVALA, NICOLE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 W RENWICK RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-436-9393
Mailing Address - Fax:
Practice Address - Street 1:24012 W RENWICK RD UNIT 14
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8731
Practice Address - Country:US
Practice Address - Phone:815-436-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily