Provider Demographics
NPI:1982378196
Name:ZIMMERMAN, MARY A (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MILLBACH RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17087-9763
Mailing Address - Country:US
Mailing Address - Phone:717-202-7185
Mailing Address - Fax:
Practice Address - Street 1:1138 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-9720
Practice Address - Country:US
Practice Address - Phone:717-786-5506
Practice Address - Fax:717-786-4011
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010469176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife