Provider Demographics
NPI:1659638922
Name:ZIMMERMAN, CHARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20611 WATERTOWN RD STE J
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-928-5900
Mailing Address - Fax:262-928-5588
Practice Address - Street 1:20611 WATERTOWN RD STE J
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-928-5900
Practice Address - Fax:262-928-5588
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-168930-7363LF0000X
WI7446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily