Provider Demographics
NPI:1376302034
Name:ZIMMERMAN, BRYAN E (CNP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:E
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21732 TOWNSHIP ROAD 156
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-9780
Mailing Address - Country:US
Mailing Address - Phone:330-401-1229
Mailing Address - Fax:
Practice Address - Street 1:21732 TOWNSHIP ROAD 156
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43845-9780
Practice Address - Country:US
Practice Address - Phone:330-401-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner