MEDICARE: SUSAN J. TIMKO

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
1	163W00000X	Registered Nurse	372330	CA

General Provider Information

NPI Number	:	1538217146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J. TIMKO

Provider Business Mailing Address
First Line	:	499 HUMBOLDT ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 HUMBOLDT ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4214
Country	:	US
Telephone Number	:	707-565-7404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/11/2014

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