Healthcare Provider Details

I. General information

NPI: 1366858508
Provider Name (Legal Business Name): LINDSAY ZIMMERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E G ST
ELIZABETHTON TN
37643-3223
US

IV. Provider business mailing address

403 E G ST
ELIZABETHTON TN
37643-3223
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2521
  • Fax: 423-543-7348
Mailing address:
  • Phone: 423-543-2521
  • Fax: 423-543-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number192515
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: