Healthcare Provider Details

I. General information

NPI: 1295366490
Provider Name (Legal Business Name): SUSAN ELIZABETH TIMMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 2ND ST NE
MINNEAPOLIS MN
55413-1662
US

IV. Provider business mailing address

2060 CENTRE POINTE BLVD STE 3
SAINT PAUL MN
55120-1271
US

V. Phone/Fax

Practice location:
  • Phone: 612-230-0737
  • Fax:
Mailing address:
  • Phone: 651-774-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1460115
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: