Healthcare Provider Details

I. General information

NPI: 1801904339
Provider Name (Legal Business Name): TIMOTHY LEE NOBBE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 MARCONI AVE
SACRAMENTO CA
95821-5303
US

IV. Provider business mailing address

3727 MARCONI AVE
SACRAMENTO CA
95821-5303
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-6500
  • Fax: 916-485-6814
Mailing address:
  • Phone: 916-485-6500
  • Fax: 916-485-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number302321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: