=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831254879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA LEE ZIMMERMAN ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 08/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 863 1400 LN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-3123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-902-2042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 LISTON ST
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51019-5022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-477-3681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A167085
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | C-APN.0004121-C-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------