Provider Demographics
NPI:1265525497
Name:ZIMMERMAN, AMANDA ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ANNE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2554 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:STE 112
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9927
Mailing Address - Country:US
Mailing Address - Phone:336-740-9444
Mailing Address - Fax:336-740-9445
Practice Address - Street 1:145 KIMEL PARK DR STE 330
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6972
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-765-8492
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101887363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMZ0186723OtherDEA
NC2758671EMedicare ID - Type Unspecified
NCS21055Medicare UPIN