Basic Information
Provider Information
NPI: 1538343538
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CURTIS
FirstName: TIMOTHY
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.C.C., C.N.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3050 11TH AVENUE DR SE
Address2:  
City: HICKORY
State: NC
PostalCode: 286028336
CountryCode: US
TelephoneNumber: 8286955900
FaxNumber: 8286954256
Practice Location
Address1: 3050 11TH AVENUE DR SE
Address2:  
City: HICKORY
State: NC
PostalCode: 286028336
CountryCode: US
TelephoneNumber: 8286955900
FaxNumber: 8286954256
Other Information
ProviderEnumerationDate: 12/27/2007
LastUpdateDate: 12/27/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
376K00000X  Y Nursing Service Related ProvidersNurse's Aide 

No ID Information.


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