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NPI Code Detail

MEDICARE: DEJA TIMMERMAN

MEDICARE: DEJA TIMMERMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse28403NE

General Provider Information

NPI Number : 1265385785
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEJA TIMMERMAN
Provider Business Mailing Address
First Line : 1811 W 2ND ST STE LL200
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-5420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1811 W 2ND ST STE LL200
Second Line : LL200
City : GRAND ISLAND
State : NE
Zip : 68803-5420
Country : US
Telephone Number : 308-382-1884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ DEJA TIMMERMAN ” Practice Location

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