Healthcare Provider Details

I. General information

NPI: 1982378196
Provider Name (Legal Business Name): MARY A ZIMMERMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 GEORGETOWN RD
CHRISTIANA PA
17509-9720
US

IV. Provider business mailing address

307 MILLBACH RD
RICHLAND PA
17087-9763
US

V. Phone/Fax

Practice location:
  • Phone: 717-786-5506
  • Fax: 717-786-4011
Mailing address:
  • Phone: 717-202-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW010469
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: