Healthcare Provider Details

I. General information

NPI: 1821287392
Provider Name (Legal Business Name): FELICIA ZIMMER APRN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

1000 THORNTON RD
BOOTHWYN PA
19061-3129
US

V. Phone/Fax

Practice location:
  • Phone: 267-761-2412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN249894L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberCNS000157
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: