Healthcare Provider Details

I. General information

NPI: 1568705747
Provider Name (Legal Business Name): BRIAN D TIMMERMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18704 E 610 RD
INOLA OK
74036-5566
US

IV. Provider business mailing address

18704 E 610 RD
INOLA OK
74036-5566
US

V. Phone/Fax

Practice location:
  • Phone: 918-633-7166
  • Fax:
Mailing address:
  • Phone: 918-633-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR64604
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: