Healthcare Provider Details

I. General information

NPI: 1043347255
Provider Name (Legal Business Name): JAN ZIMMERMAN-COLVIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E BASELINE RD STE 118
MESA AZ
85206-4626
US

IV. Provider business mailing address

4850 E BASELINE RD STE 118
MESA AZ
85206-4626
US

V. Phone/Fax

Practice location:
  • Phone: 480-461-0047
  • Fax: 480-461-1103
Mailing address:
  • Phone: 480-461-0047
  • Fax: 480-461-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN090678
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: