Provider Demographics
NPI:1730637661
Name:MAW, ALESSANDRA ZIMMERMAN (PA)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:ZIMMERMAN
Last Name:MAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALESSANDRA
Other - Middle Name:MARIANI
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1743 REDSTONE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7929
Mailing Address - Country:US
Mailing Address - Phone:435-658-9200
Mailing Address - Fax:
Practice Address - Street 1:1743 REDSTONE CENTER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7929
Practice Address - Country:US
Practice Address - Phone:435-658-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10093801-8906363A00000X
UT10093801-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant