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NPI Code Detail

MEDICARE: MRS. CONNIE ALISON ZIMMERMAN LPN

MEDICARE: MRS. CONNIE ALISON ZIMMERMAN LPN
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
1164W00000XLicensed Practical NurseP013450SD

General Provider Information

NPI Number : 1790596278
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CONNIE ALISON ZIMMERMAN LPN
Provider Business Mailing Address
First Line : 380 W ANCHOR DR
Second Line :
City : DAKOTA DUNES
State : SD
Zip : 57049-5273
Country : US
Telephone Number : 605-232-2970
Fax Number : 612-725-1097
Provider Business Practice Location Address
First Line : 380 W ANCHOR DR
Second Line :
City : DAKOTA DUNES
State : SD
Zip : 57049-5273
Country : US
Telephone Number : 605-232-2970
Fax Number : 612-725-1097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2025
Last Update Date : 01/15/2025

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