Provider Demographics
NPI:1710211370
Name:ZIMKUS, DEANNA JEAN CICHON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:JEAN CICHON
Last Name:ZIMKUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:JEAN
Other - Last Name:CICHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:464 WOLCOTT ROAD
Mailing Address - Street 2:ADVANCED DERMATOLOGY CENTER, PC
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716
Mailing Address - Country:US
Mailing Address - Phone:203-879-6171
Mailing Address - Fax:203-879-1191
Practice Address - Street 1:464 WOLCOTT ROAD
Practice Address - Street 2:ADVANCED DERMATOLOGY CENTER, PC
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716
Practice Address - Country:US
Practice Address - Phone:203-879-6171
Practice Address - Fax:203-879-1191
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant