Provider Demographics
NPI:1609311471
Name:HAHN, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HAHN
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 1:1328 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4348
Mailing Address - Country:US
Mailing Address - Phone:704-993-2107
Mailing Address - Fax:704-993-2115
Practice Address - Street 1:1328 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4348
Practice Address - Country:US
Practice Address - Phone:704-993-2107
Practice Address - Fax:704-993-2115
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001006996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant