Healthcare Provider Details

I. General information

NPI: 1619918844
Provider Name (Legal Business Name): KEITH A. ZIMMERMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL DR
OAKDALE LA
71463-3035
US

IV. Provider business mailing address

PO BOX 1105
OAKDALE LA
71463-1105
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-3700
  • Fax:
Mailing address:
  • Phone: 318-335-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP02817
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: