Provider Demographics
NPI:1669598108
Name:ZIMMERMAN, ERIN R (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 LAKE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9150
Mailing Address - Country:US
Mailing Address - Phone:812-490-9033
Mailing Address - Fax:
Practice Address - Street 1:2400 W LLOYD EXPY
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5095
Practice Address - Country:US
Practice Address - Phone:812-429-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered