Healthcare Provider Details

I. General information

NPI: 1568717015
Provider Name (Legal Business Name): TASHA ROSE ZIMMERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA ODD

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

IV. Provider business mailing address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5452
  • Fax: 541-296-5263
Mailing address:
  • Phone: 412-965-4525
  • Fax: 541-296-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number22-QMHA-R-2980
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60046483
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200940462RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: