Provider Demographics
NPI:1174607568
Name:ZINDEL, ELLEN M (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:ZINDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 E LAKE SHORE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3800
Mailing Address - Country:US
Mailing Address - Phone:217-422-6100
Mailing Address - Fax:833-784-5326
Practice Address - Street 1:1770 E LAKE SHORE DR STE 105
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3800
Practice Address - Country:US
Practice Address - Phone:217-422-6100
Practice Address - Fax:833-784-5326
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003617207RC0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILK39518Medicare PIN
ILP39696Medicare UPIN