Provider Demographics
NPI:1154320398
Name:ZIMMERMAN, JUNE N (RN,CNP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:N
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RN,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-4803
Mailing Address - Country:US
Mailing Address - Phone:320-748-7243
Mailing Address - Fax:320-748-8204
Practice Address - Street 1:115 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-4803
Practice Address - Country:US
Practice Address - Phone:320-748-7243
Practice Address - Fax:320-748-8204
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 88170-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117M7ZIOtherBLUE CROSS BLUE SHIELD MN
MN117M7ZIOtherBLUE CROSS BLUE SHIELD MN