Individual
TIMOTHY J DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1201 N MAIN ST, CROWN POINT, IN 46307-2716
(219) 757-6077
Mailing address
9318 MONROE CT, APT 509, CROWN POINT, IN 46307-6216
(708) 691-1332
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28206675A
IN
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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