Provider Demographics
NPI:1225854300
Name:TIMMERMAN, DEBRA ANN (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:STALSONBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11836 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-8845
Mailing Address - Country:US
Mailing Address - Phone:616-401-7199
Mailing Address - Fax:
Practice Address - Street 1:12800 W M 179 HWY
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9318
Practice Address - Country:US
Practice Address - Phone:616-401-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist