Healthcare Provider Details

I. General information

NPI: 1841686615
Provider Name (Legal Business Name): TIMOTHY DARLAND EMR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 STRUCK RD
LYLE WA
98635-9428
US

IV. Provider business mailing address

1 BARTLETT WAY
LYLE WA
98635-9451
US

V. Phone/Fax

Practice location:
  • Phone: 509-209-4381
  • Fax:
Mailing address:
  • Phone: 509-209-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number60081201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: