Individual
MARY K ZIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-7275
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209012398
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209012398
—
IL
Enumeration date
01/15/2015
Last updated
06/18/2020
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