Individual
TIMOTHY PRIMROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-4145
(574) 335-4146
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2057
(574) 335-8707
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71005880A
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71005880A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000969840
BCBS
IN
05
—
201327760
—
IN
Enumeration date
10/19/2015
Last updated
03/27/2024
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