Provider Demographics
NPI:1053722231
Name:TIMBO, MARIAMA (LPN)
Entity type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:TIMBO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7137 WINNOW CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6088
Mailing Address - Country:US
Mailing Address - Phone:614-537-8873
Mailing Address - Fax:
Practice Address - Street 1:7137 WINNOW CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-6088
Practice Address - Country:US
Practice Address - Phone:614-537-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN152015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse