Provider Demographics
NPI:1841484540
Name:TIMMERMAN, BILLIE JO (LPN)
Entity type:Individual
Prefix:
First Name:BILLIE JO
Middle Name:
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9507
Mailing Address - Country:US
Mailing Address - Phone:585-749-8591
Mailing Address - Fax:
Practice Address - Street 1:3621 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:NY
Practice Address - Zip Code:14568-9507
Practice Address - Country:US
Practice Address - Phone:585-749-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00262288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150012Medicaid