Provider Demographics
NPI:1093178972
Name:NIMMER, DESIREE A (CNA, MA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:NIMMER
Suffix:
Gender:F
Credentials:CNA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 S THROOP ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4439
Mailing Address - Country:US
Mailing Address - Phone:817-760-8439
Mailing Address - Fax:
Practice Address - Street 1:11415 S THROOP ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4439
Practice Address - Country:US
Practice Address - Phone:817-760-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion