Healthcare Provider Details

I. General information

NPI: 1750390837
Provider Name (Legal Business Name): TIMOTHY R. KLUDING R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

11263 QUARTZ DR
AUBURN CA
95602-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-7360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number433300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: