Individual
JOHNATHAN DAVID WIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2255 MAIN STREET, KLAMATH FALLS, OR 97601
(541) 883-2795
Mailing address
2255 MAIN STREET, KLAMATH FALLS, OR 97601
(541) 883-2795
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201394590LPN
OR
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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