Healthcare Provider Details

I. General information

NPI: 1104946870
Provider Name (Legal Business Name): ELAINE JOY ZIMMERMAN RNCDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S ELM ST STE 202
OWOSSO MI
48867-2649
US

IV. Provider business mailing address

317 S ELM ST STE 202
OWOSSO MI
48867-2649
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4700
  • Fax: 989-729-7762
Mailing address:
  • Phone: 989-729-4700
  • Fax: 989-729-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number4704133135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: