Provider Demographics
NPI:1730151093
Name:ZIMMERMAN, NICOLE DENISE (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DENISE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:44 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1700
Mailing Address - Country:US
Mailing Address - Phone:717-738-2468
Mailing Address - Fax:717-738-9936
Practice Address - Street 1:44 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1700
Practice Address - Country:US
Practice Address - Phone:717-738-2468
Practice Address - Fax:717-738-9936
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 010476 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine