Provider Demographics
NPI:1801550553
Name:SCHUIJT, TIM ROBERT
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:ROBERT
Last Name:SCHUIJT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 S UTAH AVE # 5093
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-5093
Mailing Address - Country:US
Mailing Address - Phone:208-525-2600
Mailing Address - Fax:
Practice Address - Street 1:765 S UTAH AVE # 5093
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-5093
Practice Address - Country:US
Practice Address - Phone:208-525-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID70145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily