Healthcare Provider Details

I. General information

NPI: 1861964108
Provider Name (Legal Business Name): LAURA M TIMKO RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4753
  • Fax: 907-714-4696
Mailing address:
  • Phone: 907-714-4753
  • Fax: 907-714-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: