Provider Demographics
NPI:1982093449
Name:LEREW-ZIMANSKI, ANNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:LEREW-ZIMANSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:J
Other - Last Name:LEREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1900 SILVER LAKE ROAD, NEW BRIGHTON, MN 55112
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1786
Practice Address - Country:US
Practice Address - Phone:651-731-0859
Practice Address - Fax:651-731-0976
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant