Healthcare Provider Details

I. General information

NPI: 1326383142
Provider Name (Legal Business Name): NANCY ADELAIDE ZIMMERMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 750W
LOS ANGELES CA
90048-6108
US

IV. Provider business mailing address

48 1/2 DUDLEY AVE APT 1
VENICE CA
90291-8741
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8700
  • Fax:
Mailing address:
  • Phone: 832-427-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: