Provider Demographics
NPI:1174556419
Name:ZIMMERMAN, JILL A (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:PYREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:STE 311
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-544-4411
Mailing Address - Fax:262-542-3147
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:STE 311
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-544-4411
Practice Address - Fax:262-542-3167
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1271-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174556419Medicaid
WI001468100Medicare PIN
WI02120-0306Medicare PIN
WI1174556419Medicaid
WI41930900Medicaid