MEDICARE: MS. MADELINE E ZIMMERMANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program		NH

General Provider Information

NPI Number	:	1528582293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADELINE E ZIMMERMANN

Provider Business Mailing Address
First Line	:	58 WILLARD POND RD
Second Line	:
City	:	HANCOCK
State	:	NH
Zip	:	03449-5311
Country	:	US
Telephone Number	:	603-721-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MAIN ST
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-3572
Country	:	US
Telephone Number	:	603-862-3892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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