Provider Demographics
NPI:1255062600
Name:ZIMMERMAN, NICOLE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3129 FERNDELL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:WI
Mailing Address - Zip Code:54155-9069
Mailing Address - Country:US
Mailing Address - Phone:208-866-9746
Mailing Address - Fax:
Practice Address - Street 1:2851 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5855
Practice Address - Country:US
Practice Address - Phone:208-866-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17865-401835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology