Provider Demographics
NPI:1497490601
Name:TIMMER, FONTAINE
Entity Type:Individual
Prefix:MRS
First Name:FONTAINE
Middle Name:
Last Name:TIMMER
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 1:1700 SW COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66621-0001
Mailing Address - Country:US
Mailing Address - Phone:252-744-6478
Mailing Address - Fax:
Practice Address - Street 1:1700 SW COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66621-0001
Practice Address - Country:US
Practice Address - Phone:561-385-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program