Provider Demographics
NPI:1386005601
Name:WEBER, TIMOTHY ROBERT (FNP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:WEBER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3150
Mailing Address - Country:US
Mailing Address - Phone:218-260-3350
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENUE B
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1631
Practice Address - Country:US
Practice Address - Phone:218-310-8896
Practice Address - Fax:218-206-6276
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306820101YA0400X
MNCNP 4335363LF0000X
MN4335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily