Provider Demographics
NPI:1356816243
Name:ZAMORA, MAUREEN SARES (APN)
Entity Type:Individual
Prefix:MISS
First Name:MAUREEN
Middle Name:SARES
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 RICKERT DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0954
Mailing Address - Country:US
Mailing Address - Phone:630-527-6450
Mailing Address - Fax:630-527-6456
Practice Address - Street 1:1243 RICKERT DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0954
Practice Address - Country:US
Practice Address - Phone:630-527-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018738363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.340281Medicaid