Provider Demographics
NPI:1952322299
Name:ZIMNEY, STACY J (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:ZIMNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MILL ST, PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572
Mailing Address - Country:US
Mailing Address - Phone:218-863-6100
Mailing Address - Fax:218-863-6173
Practice Address - Street 1:211 E MILL ST
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572
Practice Address - Country:US
Practice Address - Phone:218-863-6100
Practice Address - Fax:218-863-6173
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN483903000Medicaid
ND71194Medicaid
ND71194Medicaid
Q36935Medicare UPIN