Provider Demographics
NPI:1720623457
Name:TIMM, LESLIE L (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:TIMM
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:HAEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:609 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-5036
Mailing Address - Country:US
Mailing Address - Phone:402-385-3244
Mailing Address - Fax:402-385-3342
Practice Address - Street 1:609 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-5036
Practice Address - Country:US
Practice Address - Phone:402-385-3244
Practice Address - Fax:402-385-3342
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57409163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool