Provider Demographics
NPI:1275511925
Name:ZIMMERMAN MINNICH, BARBARA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:ZIMMERMAN MINNICH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-6300
Mailing Address - Country:US
Mailing Address - Phone:773-288-6900
Mailing Address - Fax:773-268-3020
Practice Address - Street 1:5401 S WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-6300
Practice Address - Country:US
Practice Address - Phone:773-288-6900
Practice Address - Fax:773-268-3020
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100316367A00000X
IL209.009431367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK41449OtherOK BOARD OF NARCOTICS AND DANGEROUS DRUGS
OK200301730AMedicaid
NV000500804Medicaid
IL309.006128OtherAPN CONTROLLED SUBSTANCE
NVCS12064OtherPHARMACY/CDS
NVCS12064OtherPHARMACY/CDS
OK200301730AMedicaid
NV000500804Medicaid
NVCS12064OtherPHARMACY/CDS