Provider Demographics
NPI:1528580917
Name:ZIMMER, NATALIE JOY (FNP-BCC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOY
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:FNP-BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W SUPERIOR ST UNIT 2610
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3588
Mailing Address - Country:US
Mailing Address - Phone:407-619-6433
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS HWY STE 206
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1146
Practice Address - Country:US
Practice Address - Phone:708-880-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner