Provider Demographics
NPI:1962189845
Name:LYTH, ZACHARY SCOTT (NP)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:SCOTT
Last Name:LYTH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2616
Mailing Address - Country:US
Mailing Address - Phone:630-835-6976
Mailing Address - Fax:
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4403
Practice Address - Country:US
Practice Address - Phone:773-282-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-09-08
Deactivation Date:2023-08-30
Deactivation Code:
Reactivation Date:2023-09-06
Provider Licenses
StateLicense IDTaxonomies
IL209028199363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care