Healthcare Provider Details

I. General information

NPI: 1275302986
Provider Name (Legal Business Name): HEATHER ZIMMERMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 BRYANT ST
LOUISVILLE IL
62858-1053
US

IV. Provider business mailing address

5809 OLD BIBLE GROVE RD
LOUISVILLE IL
62858-2643
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-2131
  • Fax:
Mailing address:
  • Phone: 217-821-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: