Provider Demographics
NPI:1427485465
Name:TIMMERMAN, MARY A (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PLATA CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3731
Mailing Address - Country:US
Mailing Address - Phone:415-408-3689
Mailing Address - Fax:
Practice Address - Street 1:715 SOUTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6835
Practice Address - Country:US
Practice Address - Phone:707-778-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-05
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18181363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care