Healthcare Provider Details

I. General information

NPI: 1750296729
Provider Name (Legal Business Name): TIMOTHY ADAMS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 ANDRIEUX ST
SONOMA CA
95476-6863
US

IV. Provider business mailing address

5063 KARRINGTON RD
ROHNERT PARK CA
94928-5046
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5100
  • Fax:
Mailing address:
  • Phone: 707-935-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95040013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: