Basic Information
| Provider Information | |||||||||
| NPI: | 1114511367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAJAC | ||||||||
| FirstName: | MARYEILEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 19-100 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126643278 | ||||||||
| FaxNumber: | 3126955774 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 19-100 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126643278 | ||||||||
| FaxNumber: | 3126955774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 209022729 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 209022729 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.