1790596278 NPI number — MRS. CONNIE ALISON ZIMMERMAN LPN

Table of content: MRS. CONNIE ALISON ZIMMERMAN LPN (NPI 1790596278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790596278 NPI number — MRS. CONNIE ALISON ZIMMERMAN LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
CONNIE
Provider Middle Name:
ALISON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LORD
Provider Other First Name:
CONNIE
Provider Other Middle Name:
ALISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790596278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 W ANCHOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAKOTA DUNES
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049-5273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-232-2970
Provider Business Mailing Address Fax Number:
612-725-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 W ANCHOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAKOTA DUNES
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57049-5273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-232-2970
Provider Business Practice Location Address Fax Number:
612-725-1097
Provider Enumeration Date:
01/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  P013450 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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