Provider Demographics
NPI:1760130090
Name:ZIMMERMAN-BATES, JENNIFER (MSN, AG-CNS, PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZIMMERMAN-BATES
Suffix:
Gender:F
Credentials:MSN, AG-CNS, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1835
Mailing Address - Country:US
Mailing Address - Phone:570-640-0010
Mailing Address - Fax:
Practice Address - Street 1:2201 RIDGEWOOD RD STE 400
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1193
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health