Provider Demographics
NPI:1568717015
Name:ZIMMERMAN, TASHA ROSE (RN)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:ROSE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:ODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:
Practice Address - Street 1:432 NE TOHOMISH ST
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1940
Practice Address - Country:US
Practice Address - Phone:509-493-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60046483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse