Provider Demographics
NPI:1356485668
Name:STORZ, TYLER G (CPED, COF)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:G
Last Name:STORZ
Suffix:
Gender:M
Credentials:CPED, COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S 70TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4283
Mailing Address - Country:US
Mailing Address - Phone:402-484-6300
Mailing Address - Fax:402-484-6302
Practice Address - Street 1:4500 S 70TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4283
Practice Address - Country:US
Practice Address - Phone:402-484-6300
Practice Address - Fax:402-484-6302
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE41206044600Medicaid
NE41206044600Medicaid