Provider Demographics
NPI:1073977500
Name:TYSON, PATRICIA E (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:TYSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4826
Mailing Address - Country:US
Mailing Address - Phone:773-220-3822
Mailing Address - Fax:
Practice Address - Street 1:7713 COLORADO ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4826
Practice Address - Country:US
Practice Address - Phone:773-220-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041304910163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicare PIN