Healthcare Provider Details

I. General information

NPI: 1063540789
Provider Name (Legal Business Name): SUSAN TIMAN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

PO BOX 715194
COLUMBUS OH
43271-5194
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-8212
  • Fax: 614-722-3235
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN166338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: