Provider Demographics
NPI:1568151611
Name:ZIMMERMANN, AMY JEAN (IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 FIELDRUSH CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3188
Mailing Address - Country:US
Mailing Address - Phone:909-904-5889
Mailing Address - Fax:
Practice Address - Street 1:7348 FIELDRUSH CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3188
Practice Address - Country:US
Practice Address - Phone:909-904-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL310464174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty