Provider Demographics
NPI:1396077012
Name:ZIMMERMAN, NIKKI LEE
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:LEE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PEARL AVE SE
Mailing Address - Street 2:APT B
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8006
Mailing Address - Country:US
Mailing Address - Phone:330-371-3187
Mailing Address - Fax:
Practice Address - Street 1:38 PEARL AVE SE
Practice Address - Street 2:APT B
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8006
Practice Address - Country:US
Practice Address - Phone:330-371-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant