Provider Demographics
NPI:1245078948
Name:ZIMMERMAN, CASSANDRA RITA (RN)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:RITA
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:RITA
Other - Last Name:GEFFRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2213 25TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5133
Mailing Address - Country:US
Mailing Address - Phone:701-899-1229
Mailing Address - Fax:
Practice Address - Street 1:5225 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7927
Practice Address - Country:US
Practice Address - Phone:701-417-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2498942163W00000X
NDR40371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse