Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 16197 | NH |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 16197 | NH |
NPI | 1124344502 |
---|---|
Provider Name | Michelle Diane Tyler |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2010 |
Last Update Date | 22/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021949 | (05) | VT |
3086958 | (05) | NH |