Provider Demographics
NPI:1477305365
Name:ZIMMERMAN, MICA (BSN, RN, DNP, CNM)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:BSN, RN, DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 SE TOLMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6974
Mailing Address - Country:US
Mailing Address - Phone:925-212-1182
Mailing Address - Fax:
Practice Address - Street 1:700 NE 87TH AVE STE AND170
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4896
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61267058163W00000X
OR202111495RN163W00000X
WAAP61565827367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse