Provider Demographics
NPI:1114474095
Name:WILSON, TYLER (CPM)
Entity Type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2904
Mailing Address - Country:US
Mailing Address - Phone:610-469-4905
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGWOOD LN
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-2904
Practice Address - Country:US
Practice Address - Phone:610-469-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16020003176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife