Provider Demographics
NPI:1447017900
Name:DZIURMAN, TIMOTHY (LPN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DZIURMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14824 W REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7434
Mailing Address - Country:US
Mailing Address - Phone:623-810-5584
Mailing Address - Fax:
Practice Address - Street 1:1234 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4274
Practice Address - Country:US
Practice Address - Phone:602-331-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP044962164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse