Provider Demographics
NPI:1689370934
Name:TYLER, MARY E (STNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:TYLER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1163
Mailing Address - Country:US
Mailing Address - Phone:614-313-0606
Mailing Address - Fax:
Practice Address - Street 1:214 W WARREN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1163
Practice Address - Country:US
Practice Address - Phone:614-313-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401079110510251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care