Provider Demographics
NPI:1639295389
Name:ZIMMERMAN, MADOLYNNE (PNP)
Entity Type:Individual
Prefix:
First Name:MADOLYNNE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:RM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3509
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:
Practice Address - Street 1:389 CONGRESS ST
Practice Address - Street 2:RM 307
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3509
Practice Address - Country:US
Practice Address - Phone:207-874-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024186363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME39359OtherHARVARD PILGRIM
MEM2048200OtherCIGNA
ME3163434OtherAETNA