Provider Demographics
NPI:1578521852
Name:TYRRELL, VICKI HELENA (MS, APRN, BC, GNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:HELENA
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MS, APRN, BC, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9711
Mailing Address - Country:US
Mailing Address - Phone:734-475-3807
Mailing Address - Fax:
Practice Address - Street 1:400 HINCKLEY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6125
Practice Address - Country:US
Practice Address - Phone:517-782-7431
Practice Address - Fax:517-782-7483
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116542363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology