Provider Demographics
NPI:1508103920
Name:ZIMLICH, CHERYL ANN (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:ZIMLICH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1055 MEDICAL PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3607
Mailing Address - Country:US
Mailing Address - Phone:616-957-2549
Mailing Address - Fax:616-464-4234
Practice Address - Street 1:5500 ARMSTRONG ROAD (11C)
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037
Practice Address - Country:US
Practice Address - Phone:616-406-6310
Practice Address - Fax:269-223-6907
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213930364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult