Healthcare Provider Details

I. General information

NPI: 1861020687
Provider Name (Legal Business Name): KORTNI DAWN ZIMMERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 LINCOLN HWY
BEDFORD PA
15522-3717
US

IV. Provider business mailing address

7594 BEDFORD VALLEY RD
BEDFORD PA
15522-6126
US

V. Phone/Fax

Practice location:
  • Phone: 814-652-3220
  • Fax: 814-652-3230
Mailing address:
  • Phone: 814-494-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN651624
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: