MEDICARE: THERESA M ZIMMERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN. 097119	OH
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1275662132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA M ZIMMERMAN

Provider Business Mailing Address
First Line	:	18793 HUPRICK RD
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9514
Country	:	US
Telephone Number	:	330-682-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	18823 HUPRICK RD
Second Line	:
City	:	NORTH LAWRENCE
State	:	OH
Zip	:	44666-9556
Country	:	US
Telephone Number	:	330-682-5665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/11/2025

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