Individual
JENNIFER R ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 274-4779
(317) 948-9806
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.021197
IL
363LN0000X
Neonatal Nurse Practitioner
209.021197
IL
363LN0000X
Neonatal Nurse Practitioner
Primary
71015479A
IN
363LN0005X
Critical Care Neonatal Nurse Practitioner
10293
WI
363LN0005X
Critical Care Neonatal Nurse Practitioner
209.021197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300084977
—
IN
Enumeration date
05/28/2020
Last updated
12/11/2024
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