Provider Demographics
NPI:1699874511
Name:ZIMMERMAN, DIANE B (PA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 S GREENLEAF ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3380
Mailing Address - Country:US
Mailing Address - Phone:847-599-8899
Mailing Address - Fax:847-599-8897
Practice Address - Street 1:103 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3380
Practice Address - Country:US
Practice Address - Phone:847-599-8899
Practice Address - Fax:847-599-8897
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ36921Medicare UPIN