Provider Demographics
NPI:1073872255
Name:ZIMMERMANN, LINDA ANNE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:ZIMMERMANN
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 1:10701 OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3915
Mailing Address - Country:US
Mailing Address - Phone:718-592-9788
Mailing Address - Fax:
Practice Address - Street 1:10701 OTIS AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3915
Practice Address - Country:US
Practice Address - Phone:718-592-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22406519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse