Provider Demographics
NPI:1619525813
Name:ZIMMERMAN, RITA ANN
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FRENSLEY ST SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4953
Mailing Address - Country:US
Mailing Address - Phone:580-490-2907
Mailing Address - Fax:
Practice Address - Street 1:1219 K ST NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1801
Practice Address - Country:US
Practice Address - Phone:580-798-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator