Provider Demographics
NPI:1164003554
Name:CONNOR, TYANNA (RN)
Entity Type:Individual
Prefix:
First Name:TYANNA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TYANNA
Other - Middle Name:
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2710 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3357
Mailing Address - Country:US
Mailing Address - Phone:810-210-8123
Mailing Address - Fax:
Practice Address - Street 1:2710 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-3357
Practice Address - Country:US
Practice Address - Phone:810-210-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247965163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse