Provider Demographics
NPI:1215406079
Name:ZIMMERMAN, MAUREEN COLLEARY (RDN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:COLLEARY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 S MORROW ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3978
Mailing Address - Country:US
Mailing Address - Phone:480-329-5481
Mailing Address - Fax:
Practice Address - Street 1:2735 S MORROW ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3978
Practice Address - Country:US
Practice Address - Phone:480-329-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
ILR591871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist