Provider Demographics
NPI:1629302872
Name:ASHLEY ZIMDAHL
Entity Type:Organization
Organization Name:ASHLEY ZIMDAHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIMDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-602-6063
Mailing Address - Street 1:N2364 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-2038
Mailing Address - Country:US
Mailing Address - Phone:920-602-6063
Mailing Address - Fax:
Practice Address - Street 1:N2364 SUNSET DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-2038
Practice Address - Country:US
Practice Address - Phone:920-602-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1677060303140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric