Healthcare Provider Details

I. General information

NPI: 1780626739
Provider Name (Legal Business Name): PENELOPE PIPHO ZIMMERMAN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 W MOREHEAD ST STE 102
CHARLOTTE NC
28208-5145
US

IV. Provider business mailing address

2000 16TH ST
DENVER CO
80202-5117
US

V. Phone/Fax

Practice location:
  • Phone: 704-335-0151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number960068
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number960068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: