Provider Demographics
NPI:1780631192
Name:ZIMMERMAN, DEANE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 PEBBLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-4200
Mailing Address - Country:US
Mailing Address - Phone:218-205-4529
Mailing Address - Fax:972-983-0246
Practice Address - Street 1:3417 PEBBLE HILLS DR
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4200
Practice Address - Country:US
Practice Address - Phone:218-205-4529
Practice Address - Fax:972-983-0246
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN073376367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered