Provider Demographics
NPI:1568458610
Name:ZIMMER, DEBRA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 E MOUNT EDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-5309
Mailing Address - Country:US
Mailing Address - Phone:812-896-7301
Mailing Address - Fax:812-258-3438
Practice Address - Street 1:6711 E MOUNT EDEN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170
Practice Address - Country:US
Practice Address - Phone:812-896-7301
Practice Address - Fax:812-258-3438
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001236A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200406830Medicaid
IN200406830Medicaid
IN186830KIMedicare ID - Type Unspecified
IN232320EMedicare PIN
INM400070276Medicare PIN