Provider Demographics
NPI:1609993534
Name:ZIMMERMAN, ADRIENNE ELISE (PAC)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:ELISE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:81423-0280
Mailing Address - Country:US
Mailing Address - Phone:970-327-4233
Mailing Address - Fax:970-327-4228
Practice Address - Street 1:1350 S ASPEN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423-0280
Practice Address - Country:US
Practice Address - Phone:970-327-4233
Practice Address - Fax:970-327-4228
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004052363AS0400X, 363A00000X
COPA.0006232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN99790006Medicare ID - Type Unspecified
MIP94827Medicare UPIN