Provider Demographics
NPI:1548662919
Name:ZIMMERMAN, JACQUI L (RD, LDN)
Entity type:Individual
Prefix:
First Name:JACQUI
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5635
Mailing Address - Country:US
Mailing Address - Phone:717-314-7850
Mailing Address - Fax:
Practice Address - Street 1:1632 ROBERT RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5635
Practice Address - Country:US
Practice Address - Phone:717-314-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered