Provider Demographics
NPI:1275662132
Name:ZIMMERMAN, THERESA M
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:ZIMMERMAN
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 1:18793 HUPRICK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9514
Mailing Address - Country:US
Mailing Address - Phone:330-682-5665
Mailing Address - Fax:
Practice Address - Street 1:18823 HUPRICK RD
Practice Address - Street 2:
Practice Address - City:NORTH LAWRENCE
Practice Address - State:OH
Practice Address - Zip Code:44666-9556
Practice Address - Country:US
Practice Address - Phone:330-682-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 097119164W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide