1295138725 NPI number — MRS. AMY MARIE TIMMINS PA-C

Table of content: RAMON VILLEZAR DELEON MD (NPI 1376614602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295138725 NPI number — MRS. AMY MARIE TIMMINS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMMINS
Provider First Name:
AMY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASELLE
Provider Other First Name:
AMY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295138725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 GREEN RD
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48105-1598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-995-3764
Provider Business Mailing Address Fax Number:
734-995-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 GREEN RD
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48105-1598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-995-3764
Provider Business Practice Location Address Fax Number:
734-995-2913
Provider Enumeration Date:
09/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601007210 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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