Provider Demographics
NPI:1780246884
Name:ZIMMERMAN, PAMELA J (LPN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-7403
Mailing Address - Country:US
Mailing Address - Phone:217-497-0449
Mailing Address - Fax:
Practice Address - Street 1:931 N HAZEL ST # SY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3019
Practice Address - Country:US
Practice Address - Phone:217-597-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-073534164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse