Provider Demographics
NPI:1326120163
Name:NORDNESS, TYANN (CNM)
Entity Type:Individual
Prefix:
First Name:TYANN
Middle Name:
Last Name:NORDNESS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2214
Mailing Address - Country:US
Mailing Address - Phone:860-886-2461
Mailing Address - Fax:860-887-8530
Practice Address - Street 1:17 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2214
Practice Address - Country:US
Practice Address - Phone:860-886-2461
Practice Address - Fax:860-887-8530
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000145367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife