MEDICARE: MR. TIMOTHY ALAN TRAUTMAN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	81001709	OR

General Provider Information

NPI Number	:	1689798118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY ALAN TRAUTMAN ANP

Provider Business Mailing Address
First Line	:	PO BOX 461
Second Line	:	1120 MILL ST. SUITE 2
City	:	WALDPORT
State	:	OR
Zip	:	97394-0461
Country	:	US
Telephone Number	:	541-563-5080
Fax Number	:	541-563-5090

Provider Business Practice Location Address
First Line	:	1120 MILL ST.
Second Line	:	SUITE 2
City	:	WALDPORT
State	:	OR
Zip	:	97394-0461
Country	:	US
Telephone Number	:	541-563-5080
Fax Number	:	541-563-5090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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