Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 200700299228 | VA |
NPI | 1033482617 |
---|---|
Provider Name | Evelyn Jean Tyler |
First Address | Fpo, AP 96362-9998 |
Second Address | Fpo, AP 96362-9998 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2012 |
Last Update Date | 13/02/2012 |