Provider Demographics
NPI:1477585644
Name:KUROKAWA, TIMOTHY JAMES (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:KUROKAWA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 6TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201
Mailing Address - Country:US
Mailing Address - Phone:406-653-1641
Mailing Address - Fax:406-653-3728
Practice Address - Street 1:BOX 729
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN11344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP38348Medicare UPIN