Provider Demographics
NPI:1992037774
Name:ZIMMERMAN, EMILY M (CRNA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:KURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-0001
Mailing Address - Country:US
Mailing Address - Phone:217-788-3000
Mailing Address - Fax:
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-1830
Practice Address - Country:US
Practice Address - Phone:217-788-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041349275OtherRN LICENSE
WI543400638Medicare PIN
WI741501909Medicare PIN
WI61307OtherDEAN HEALTH INSURANCE