Healthcare Provider Details

I. General information

NPI: 1861630097
Provider Name (Legal Business Name): TERRI A ZIMON A ZIMON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 N US HIGHWAY 301
WHITAKERS NC
27891-8621
US

IV. Provider business mailing address

9377 N US HIGHWAY 301
WHITAKERS NC
27891-8621
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-4394
  • Fax:
Mailing address:
  • Phone: 503-215-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number098006717N3 ANP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30007370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: