Provider Demographics
NPI:1437512852
Name:CZARNECKI, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CZARNECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 DELMAR BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2170
Mailing Address - Country:US
Mailing Address - Phone:636-465-3333
Mailing Address - Fax:
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:636-465-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide