Provider Demographics
NPI:1700816568
Name:ZIMMER, PAULA S
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:S
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:S
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2740
Mailing Address - Country:US
Mailing Address - Phone:518-384-1507
Mailing Address - Fax:
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5918
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4300063363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02968032Medicaid