Provider Demographics
NPI:1548652811
Name:ZIMMERMANN, LISA (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 N LEAVITT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1309
Mailing Address - Country:US
Mailing Address - Phone:773-392-3278
Mailing Address - Fax:
Practice Address - Street 1:4944 N LEAVITT ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1309
Practice Address - Country:US
Practice Address - Phone:773-392-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-67598174N00000X
IL041.366629163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163W00000XNursing Service ProvidersRegistered Nurse