Provider Demographics
NPI:1235748898
Name:TYSON, DANIELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
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 1:228 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1528
Mailing Address - Country:US
Mailing Address - Phone:334-695-0144
Mailing Address - Fax:
Practice Address - Street 1:228 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1528
Practice Address - Country:US
Practice Address - Phone:334-695-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135774163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine