Provider Demographics
NPI:1265728414
Name:TYSON, BARBARA SUZANNE
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUZANNE
Last Name:TYSON
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:P.O. BOX 3913
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203
Mailing Address - Country:US
Mailing Address - Phone:313-333-4292
Mailing Address - Fax:
Practice Address - Street 1:301 GLENDALE ST
Practice Address - Street 2:APT B8
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203
Practice Address - Country:US
Practice Address - Phone:954-678-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health