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General NPI Number Information
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NPI Number | 1255062600
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Entity Type | Individual
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Provider Name | NICOLE LYNN ZIMMERMAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2851 UNIVERSITY AVE
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City | GREEN BAY
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State | WI
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Zip | 54311-5855
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Country | US
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Telephone | 208-866-9746
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 FERNDELL ACRES DR
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City | HOBART
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State | WI
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Zip | 54155-9069
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Country | US
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Telephone | 208-866-9746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | 17865-40
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License Number State | WI
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