Provider Demographics
NPI:1801345707
Name:ZENKE, MARK DAVID (MSN APRN FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:ZENKE
Suffix:
Gender:M
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1442
Mailing Address - Country:US
Mailing Address - Phone:815-942-3000
Mailing Address - Fax:815-942-2333
Practice Address - Street 1:219 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1442
Practice Address - Country:US
Practice Address - Phone:815-942-3000
Practice Address - Fax:815-942-2333
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041398904163W00000X
IL209015206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse