Healthcare Provider Details

I. General information

NPI: 1881219087
Provider Name (Legal Business Name): KARRI DEEANN ZIMMERMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W HARVARD AVE
ROSEBURG OR
97471-2838
US

IV. Provider business mailing address

PO BOX 1738
SUTHERLIN OR
97479-1738
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-3355
  • Fax:
Mailing address:
  • Phone: 541-430-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4624
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: