Provider Demographics
NPI:1700319746
Name:ANDERSEN, TYLER (RN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4762
Mailing Address - Country:US
Mailing Address - Phone:402-321-3982
Mailing Address - Fax:
Practice Address - Street 1:10011 J ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1106
Practice Address - Country:US
Practice Address - Phone:402-896-9988
Practice Address - Fax:402-896-6111
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse