Provider Demographics
NPI:1023756459
Name:SAMPSON, TYLER NICOLE
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:NICOLE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SOUTH SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060
Mailing Address - Country:US
Mailing Address - Phone:937-844-6273
Mailing Address - Fax:
Practice Address - Street 1:106 SOUTH SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060
Practice Address - Country:US
Practice Address - Phone:937-844-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker