Provider Demographics
NPI:1689155137
Name:ZIMSKE, EMILY AMANDA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:AMANDA
Last Name:ZIMSKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3873
Mailing Address - Country:US
Mailing Address - Phone:314-609-1910
Mailing Address - Fax:
Practice Address - Street 1:51 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-8427
Practice Address - Country:US
Practice Address - Phone:765-795-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002543A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine