Provider Demographics
NPI:1316927635
Name:ZIMMERMAN-GOLDEN, JOYCE ELLEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ELLEN
Last Name:ZIMMERMAN-GOLDEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E PARK BLVD IDAHO CENTER FOR REPRODUCTIVE MEDICINE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712
Mailing Address - Country:US
Mailing Address - Phone:208-342-5900
Mailing Address - Fax:208-342-2088
Practice Address - Street 1:1000 E PARK BLVD IDAHO CENTER FOR REPRODUCTIVE MEDICINE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712
Practice Address - Country:US
Practice Address - Phone:208-342-5900
Practice Address - Fax:208-342-2088
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11363LW0102X
ID63089363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS47180Medicare UPIN
AK150239Medicare ID - Type UnspecifiedNORIDIAN MEDICARE