Provider Demographics
NPI:1972720449
Name:ZIMMER, RENAE C (CRNA)
Entity Type:Individual
Prefix:MS
First Name:RENAE
Middle Name:C
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:RENAE
Other - Middle Name:C
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13370 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9470
Mailing Address - Country:US
Mailing Address - Phone:661-714-0002
Mailing Address - Fax:
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4024
Practice Address - Country:US
Practice Address - Phone:818-348-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3485367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5466050Medicaid
CARN5466050Medicaid