1265813232 NPI number — HAYLEY MIGNONNE TIMM M.D.

Table of content: MARC PATRICK DAVIS MSW, MT-BC (NPI 1538943923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265813232 NPI number — HAYLEY MIGNONNE TIMM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMM
Provider First Name:
HAYLEY
Provider Middle Name:
MIGNONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FABER
Provider Other First Name:
HAYLEY
Provider Other Middle Name:
MIGNONNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265813232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20011 MANDERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHORN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68022-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-955-7840
Provider Business Mailing Address Fax Number:
402-955-7841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20011 MANDERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68022-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-955-7840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2015

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: 208000000X , with the licence number:  4301107501 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD-44939 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 33863 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265813232 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731712 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".