Provider Demographics
NPI:1093576423
Name:EISON, TYLEA (DNP, CNM)
Entity Type:Individual
Prefix:
First Name:TYLEA
Middle Name:
Last Name:EISON
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 69TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3408
Mailing Address - Country:US
Mailing Address - Phone:619-261-1036
Mailing Address - Fax:
Practice Address - Street 1:2024 69TH ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3408
Practice Address - Country:US
Practice Address - Phone:619-261-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife