Provider Demographics
NPI:1821356718
Name:KAKHRAMANOV, TIMUR (CRNP)
Entity Type:Individual
Prefix:
First Name:TIMUR
Middle Name:
Last Name:KAKHRAMANOV
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W.BYBERRY RD
Mailing Address - Street 2:UNIT F-6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:717-856-0735
Mailing Address - Fax:
Practice Address - Street 1:301 W.BYBERRY RD
Practice Address - Street 2:UNIT F-6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:717-856-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily