Provider Demographics
NPI:1952409799
Name:ZIMMERMANN, KATHERINE P (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:P
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CAMPUS RIDGE DR STE 2700
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6128
Mailing Address - Country:US
Mailing Address - Phone:989-839-3385
Mailing Address - Fax:
Practice Address - Street 1:4201 CAMPUS RIDGE DR STE 2700
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6128
Practice Address - Country:US
Practice Address - Phone:989-839-3385
Practice Address - Fax:989-839-1491
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKZ135771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS43970Medicare UPIN