Provider Demographics
NPI:1619485091
Name:FIELDS, TYIA VANESSA (LVN)
Entity Type:Individual
Prefix:
First Name:TYIA
Middle Name:VANESSA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 CAMINO DE LAS PALMAS
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3308
Mailing Address - Country:US
Mailing Address - Phone:619-917-4056
Mailing Address - Fax:
Practice Address - Street 1:2504 CAMINO DE LAS PALMAS
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3308
Practice Address - Country:US
Practice Address - Phone:619-917-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN121048164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse