Provider Demographics
NPI:1659513810
Name:ZIMMERMAN, DENISE (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17785 MENNELL RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9257
Mailing Address - Country:US
Mailing Address - Phone:440-926-3882
Mailing Address - Fax:855-247-8787
Practice Address - Street 1:1001 LAKESIDE AVE E
Practice Address - Street 2:#1000
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1158
Practice Address - Country:US
Practice Address - Phone:440-812-7786
Practice Address - Fax:855-247-8787
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 122576 NS-08831364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2970889Medicaid
OHNSO441Medicare Oscar/Certification