Provider Demographics
NPI:1104946870
Name:ZIMMERMAN, ELAINE JOY (RNCDE)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:JOY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RNCDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S ELM ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2649
Mailing Address - Country:US
Mailing Address - Phone:989-729-4700
Mailing Address - Fax:989-729-7762
Practice Address - Street 1:317 S ELM ST STE 202
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2649
Practice Address - Country:US
Practice Address - Phone:989-729-4700
Practice Address - Fax:989-729-7762
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704133135163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator