Provider Demographics
NPI:1073378147
Name:TRYON, EDDIE (CNA)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:TRYON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 19TH AVE W
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-4030
Mailing Address - Country:US
Mailing Address - Phone:406-261-3693
Mailing Address - Fax:
Practice Address - Street 1:403 19TH AVE W
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-4030
Practice Address - Country:US
Practice Address - Phone:406-261-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT362827253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care