Provider Demographics
NPI:1609029735
Name:ZIMMERMAN, RICHARD IVAN JR (RN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:IVAN
Last Name:ZIMMERMAN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-4596
Mailing Address - Country:US
Mailing Address - Phone:781-314-3314
Mailing Address - Fax:
Practice Address - Street 1:119 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-4596
Practice Address - Country:US
Practice Address - Phone:781-314-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238448163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse