Provider Demographics
NPI:1063508414
Name:TIMMONS, WENDY ROBERTA (PAC)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ROBERTA
Last Name:TIMMONS
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ROBERTA
Other - Last Name:OOSTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:303 CATLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1947
Practice Address - Country:US
Practice Address - Phone:763-684-6160
Practice Address - Fax:612-262-8766
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10167207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology