Provider Demographics
NPI:1265400196
Name:ZIMMERMAN, KARI ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:KARI
Middle Name:ELIZABETH
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KARI
Other - Middle Name:ELIZABETH
Other - Last Name:GERVAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:586-228-4652
Mailing Address - Fax:586-228-4520
Practice Address - Street 1:3170 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1488
Practice Address - Country:US
Practice Address - Phone:810-364-7277
Practice Address - Fax:810-364-2349
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704128386363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4818114Medicaid
MI4704128386OtherLICENSE
MI4704128386OtherLICENSE
Q61800Medicare UPIN
MI4818114Medicaid