Provider Demographics
NPI:1689811028
Name:ZIMMERMAN, CHRISTINE R (MPH RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MPH RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 COLE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3405
Mailing Address - Country:US
Mailing Address - Phone:720-284-7276
Mailing Address - Fax:
Practice Address - Street 1:1536 COLE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3405
Practice Address - Country:US
Practice Address - Phone:720-284-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133VN1005X, 174H00000X
CO861154133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015087Medicaid
CO04015087Medicaid
COCOA100131Medicare PIN