Healthcare Provider Details

I. General information

NPI: 1366367161
Provider Name (Legal Business Name): DEANNA TIMLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 AMHERST AVE
SHEBOYGAN FALLS WI
53085-1735
US

IV. Provider business mailing address

W6448 LAKE ELLEN DR
CASCADE WI
53011-1366
US

V. Phone/Fax

Practice location:
  • Phone: 920-467-7880
  • Fax: 920-870-0846
Mailing address:
  • Phone: 920-467-7880
  • Fax: 920-870-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number154910-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: