Healthcare Provider Details

I. General information

NPI: 1811057094
Provider Name (Legal Business Name): JOANNE MARIE ZIMMERLY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

IV. Provider business mailing address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax: 773-650-1218
Mailing address:
  • Phone: 773-254-1400
  • Fax: 773-650-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209003500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: