Provider Demographics
NPI:1801560040
Name:KOEHN, TIMOTHY LYNN
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LYNN
Last Name:KOEHN
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 1:14340 67TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-9149
Mailing Address - Country:US
Mailing Address - Phone:701-520-1103
Mailing Address - Fax:
Practice Address - Street 1:6927 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-9215
Practice Address - Country:US
Practice Address - Phone:701-352-3384
Practice Address - Fax:701-352-3384
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant