Provider Demographics
NPI:1215523170
Name:TIMKO, BEATRICE DAWN
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:DAWN
Last Name:TIMKO
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 1:6925 S KARNS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-9716
Mailing Address - Country:US
Mailing Address - Phone:937-974-2032
Mailing Address - Fax:
Practice Address - Street 1:6925 S KARNS RD
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-9716
Practice Address - Country:US
Practice Address - Phone:937-974-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075085Medicaid