Provider Demographics
NPI:1326383142
Name:ZIMMERMAN, NANCY ADELAIDE (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ADELAIDE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 1/2 DUDLEY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-8741
Mailing Address - Country:US
Mailing Address - Phone:832-427-9857
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 750W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6108
Practice Address - Country:US
Practice Address - Phone:310-659-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22159363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health