Provider Demographics
NPI:1457016156
Name:ZIMMER, NATALIE ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROSE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9528
Mailing Address - Country:US
Mailing Address - Phone:315-288-4006
Mailing Address - Fax:
Practice Address - Street 1:8003 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9528
Practice Address - Country:US
Practice Address - Phone:315-288-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027590-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant