Provider Demographics
NPI:1356707624
Name:UNGER, TIMOTHY LEE (RN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:UNGER
Suffix:
Gender:M
Credentials:RN
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 1041
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-1041
Mailing Address - Country:US
Mailing Address - Phone:503-789-8402
Mailing Address - Fax:503-663-1585
Practice Address - Street 1:3785 SE 317TH AVE
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-9401
Practice Address - Country:US
Practice Address - Phone:503-789-8402
Practice Address - Fax:503-663-1595
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091000453RN163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health