Provider Demographics
NPI:1346915915
Name:TIMBERLAKE, EMMA RUTH
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RUTH
Last Name:TIMBERLAKE
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 1:685 RESIDENZ PKWY APT A
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6306
Mailing Address - Country:US
Mailing Address - Phone:937-510-1918
Mailing Address - Fax:
Practice Address - Street 1:685 RESIDENZ PKWY APT A
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6306
Practice Address - Country:US
Practice Address - Phone:937-510-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker