Provider Demographics
NPI:1265716070
Name:ZIMMER, NANCY AMANDA (LPN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:AMANDA
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 NIAGARA PL
Mailing Address - Street 2:APT2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-2040
Mailing Address - Country:US
Mailing Address - Phone:814-504-6113
Mailing Address - Fax:
Practice Address - Street 1:4107 NIAGARA PL
Practice Address - Street 2:APT2
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-2040
Practice Address - Country:US
Practice Address - Phone:814-504-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276516164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse