Basic Information
Provider Information
NPI: 1235660036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIMMERMAN
FirstName: DAYNA
MiddleName: LYN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13001 E. 17TH PLACE
Address2:  
City: AURORA
State: CO
PostalCode: 800452581
CountryCode: US
TelephoneNumber: 7207773846
FaxNumber: 7207777258
Practice Location
Address1: 13001 E. 17TH PLACE
Address2:  
City: AURORA
State: CO
PostalCode: 800452581
CountryCode: US
TelephoneNumber: 7207773846
FaxNumber: 7207777258
Other Information
ProviderEnumerationDate: 03/23/2017
LastUpdateDate: 03/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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