Provider Demographics
NPI:1043089097
Name:ZIMMERMAN, TAYLOR (RDN)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5529
Mailing Address - Country:US
Mailing Address - Phone:208-340-5025
Mailing Address - Fax:
Practice Address - Street 1:521 N 17TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5529
Practice Address - Country:US
Practice Address - Phone:208-340-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered