Healthcare Provider Details

I. General information

NPI: 1336777267
Provider Name (Legal Business Name): STEPHANIE ZIMMERMAN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 04/08/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 SMITH AVE N STE 404
SAINT PAUL MN
55102-3354
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD STE 600
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6624
  • Fax:
Mailing address:
  • Phone: 952-993-2048
  • Fax: 952-993-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: