Basic Information
| Provider Information | |||||||||
| NPI: | 1982378196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 MILLBACH RD | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170879763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172027185 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1138 GEORGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CHRISTIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175099720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177865506 | ||||||||
| FaxNumber: | 7177864011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | MW010469 | PA | Y | Other Service Providers | Midwife |
No ID Information.