Provider Demographics
NPI:1730232901
Name:ZIMMERMAN, BETTY ANN (CNM)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
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 1:1713 170TH ST
Mailing Address - Street 2:
Mailing Address - City:WOLVERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56594-9567
Mailing Address - Country:US
Mailing Address - Phone:218-995-2271
Mailing Address - Fax:
Practice Address - Street 1:413 3RD AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4427
Practice Address - Country:US
Practice Address - Phone:701-642-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR20308367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife