Provider Demographics
NPI:1740007731
Name:TIMLIN, BREA KAY
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:KAY
Last Name:TIMLIN
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 1:2778 OCARINA DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-4609
Mailing Address - Country:US
Mailing Address - Phone:320-281-8504
Mailing Address - Fax:
Practice Address - Street 1:2778 OCARINA DR
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-4609
Practice Address - Country:US
Practice Address - Phone:320-281-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN824230164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse