Provider Demographics
NPI:1780306969
Name:ZIMMERMAN, JENNI LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:LEE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 KENNEBEC RD
Mailing Address - Street 2:
Mailing Address - City:DIXMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04932-3642
Mailing Address - Country:US
Mailing Address - Phone:207-416-2947
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4163
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5483
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221467363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care