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General NPI Number Information
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NPI Number | 1235655036
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Entity Type | Individual
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Provider Name | TIMOTHY SCOTT WACKERLE AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 363 FREMONT ST STE 100
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3395
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Country | US
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Telephone | 269-969-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 601 JOHN STREET BOX 39
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City | KALAMAZOO
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State | MI
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Zip | 49007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704229024
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License Number State | MI
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