Individual
ANCY ZACHARIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1800 N MAIN ST, SECOND FLOOR, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Mailing address
1800 N MAIN ST, SECOND FLOOR, WHEATON, IL 60187-3112
(630) 614-4960
(630) 682-3727
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209000424
IL
363LG0600X
Gerontology Nurse Practitioner
041287164
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041287164
—
IL
01
—
208015
MEDICARE GROUP NUMBER
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
CE8854
RR MEDICARE PTAN (GROUP)
IL
01
—
K03097
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P00068858
RR MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
02/05/2007
Last updated
04/15/2013
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