Provider Demographics
NPI:1861020687
Name:ZIMMERMAN, KORTNI DAWN (RN)
Entity type:Individual
Prefix:MRS
First Name:KORTNI
Middle Name:DAWN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 BEDFORD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-6126
Mailing Address - Country:US
Mailing Address - Phone:814-494-0928
Mailing Address - Fax:
Practice Address - Street 1:9709 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:814-652-3230
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN651624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse