Provider Demographics
NPI:1508749615
Name:RAFFERTY, ZANETA
Entity type:Individual
Prefix:
First Name:ZANETA
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3013
Mailing Address - Country:US
Mailing Address - Phone:773-414-9472
Mailing Address - Fax:
Practice Address - Street 1:230 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3013
Practice Address - Country:US
Practice Address - Phone:773-414-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.435308163W00000X, 163WP0200X
IL041435308163WP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics