Healthcare Provider Details

I. General information

NPI: 1417523929
Provider Name (Legal Business Name): NOAH ZACHARY CIMA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

3332 W ST
WASHOUGAL WA
98671-8929
US

V. Phone/Fax

Practice location:
  • Phone: 800-465-3203
  • Fax:
Mailing address:
  • Phone: 360-609-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61130322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: