Provider Demographics
NPI:1386758084
Name:TIMMERMAN, DENISE A (RN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-0622
Mailing Address - Country:US
Mailing Address - Phone:605-647-2841
Mailing Address - Fax:605-647-2843
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:SD
Practice Address - Zip Code:57039-0662
Practice Address - Country:US
Practice Address - Phone:605-647-2841
Practice Address - Fax:605-647-2843
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR033319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine