Provider Demographics
NPI:1972255784
Name:ZIMMERMAN, ASHLEY J (RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 650 N
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:IN
Mailing Address - Zip Code:46001-8622
Mailing Address - Country:US
Mailing Address - Phone:765-360-9883
Mailing Address - Fax:
Practice Address - Street 1:311 E 650 N
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8622
Practice Address - Country:US
Practice Address - Phone:765-360-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223816A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty