Provider Demographics
NPI:1881219087
Name:ZIMMERMAN, KARRI DEEANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KARRI
Middle Name:DEEANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-1738
Mailing Address - Country:US
Mailing Address - Phone:541-430-5894
Mailing Address - Fax:
Practice Address - Street 1:1313 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2838
Practice Address - Country:US
Practice Address - Phone:541-673-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4624124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist