Provider Demographics
NPI:1083476675
Name:TYNES, IEASHA
Entity Type:Individual
Prefix:
First Name:IEASHA
Middle Name:
Last Name:TYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LONGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1473
Mailing Address - Country:US
Mailing Address - Phone:614-716-9632
Mailing Address - Fax:
Practice Address - Street 1:500 LONGVIEW ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1473
Practice Address - Country:US
Practice Address - Phone:614-716-9632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty