Individual
TRACY ZIMMERMAN-DESCHEPPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
28 NW 4TH STREET, SUITE A, GRAND RAPIDS, MN 55744-2714
(218) 326-1274
Mailing address
28 NW 4TH STREET, SUITE A, GRAND RAPIDS, MN 55744-2714
(218) 999-7750
(218) 999-9461
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2014011459
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP3914
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72560NO
BCBS
MN
05
—
894755400
—
MN
01
—
CO8154
MEDICARE PTAN
MN
Enumeration date
09/24/2014
Last updated
05/25/2023
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