Provider Demographics
NPI:1689798118
Name:TRAUTMAN, TIMOTHY ALAN (ANP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:TRAUTMAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:1120 MILL ST. SUITE 2
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-0461
Mailing Address - Country:US
Mailing Address - Phone:541-563-5080
Mailing Address - Fax:541-563-5090
Practice Address - Street 1:1120 MILL ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-0461
Practice Address - Country:US
Practice Address - Phone:541-563-5080
Practice Address - Fax:541-563-5090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR81001709363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health