Provider Demographics
NPI:1598425613
Name:ALBRECHT, TYLER ISSAAC
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ISSAAC
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:TYLER
Other - Last Name:REVOLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1907
Mailing Address - Country:US
Mailing Address - Phone:907-745-2634
Mailing Address - Fax:
Practice Address - Street 1:11921 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8833
Practice Address - Country:US
Practice Address - Phone:907-745-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist