Provider Demographics
NPI:1235884206
Name:TIMMONS, LORI (CNA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14567 BIG BASIN WAY STE A3
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6039
Mailing Address - Country:US
Mailing Address - Phone:408-314-9997
Mailing Address - Fax:650-332-2904
Practice Address - Street 1:14567 BIG BASIN WAY STE A3
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6039
Practice Address - Country:US
Practice Address - Phone:408-314-9997
Practice Address - Fax:650-332-2904
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01191648376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide