Provider Demographics
NPI:1548612203
Name:BREDE, TYAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:TYAN
Middle Name:MARIE
Last Name:BREDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:CEYLON
Mailing Address - State:MN
Mailing Address - Zip Code:56121-0054
Mailing Address - Country:US
Mailing Address - Phone:507-848-3129
Mailing Address - Fax:507-632-4273
Practice Address - Street 1:102 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CEYLON
Practice Address - State:MN
Practice Address - Zip Code:56121-4033
Practice Address - Country:US
Practice Address - Phone:507-848-3129
Practice Address - Fax:507-632-4273
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi