Provider Demographics
NPI:1144589417
Name:TIMMERMAN, KRISTEN JO
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:JO
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3641
Mailing Address - Country:US
Mailing Address - Phone:563-583-7379
Mailing Address - Fax:563-583-8846
Practice Address - Street 1:1690 ELM ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3686
Practice Address - Country:US
Practice Address - Phone:563-291-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295164183500000X
IA21519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist