Provider Demographics
NPI:1629870399
Name:ZUMDAHL, AUDREANA STACEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUDREANA
Middle Name:STACEY
Last Name:ZUMDAHL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AUDREANA
Other - Middle Name:STACEY
Other - Last Name:FRANCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 KIWANIS DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6907
Mailing Address - Country:US
Mailing Address - Phone:815-235-1406
Mailing Address - Fax:
Practice Address - Street 1:1301 KIWANIS DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6907
Practice Address - Country:US
Practice Address - Phone:815-235-1406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI209032007363L00000X
IL209.032007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner