Provider Demographics
NPI:1073587085
Name:ZIMMERMAN, BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 13TH CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-6317
Mailing Address - Country:US
Mailing Address - Phone:701-873-2952
Mailing Address - Fax:
Practice Address - Street 1:1101 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6215
Practice Address - Country:US
Practice Address - Phone:701-873-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR18074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11992Medicaid
ND11992Medicaid
NDR02367Medicare UPIN