1912627639 NPI number — TYFANI LYNN DEAN CERTIFIED NURSE AID

Table of content: TYFANI LYNN DEAN CERTIFIED NURSE AID (NPI 1912627639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912627639 NPI number — TYFANI LYNN DEAN CERTIFIED NURSE AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAN
Provider First Name:
TYFANI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSE AID
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMOND
Provider Other First Name:
TYFANI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912627639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 NE HAYES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50849-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-303-7110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 SUMMERSET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANELLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50846-8098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-745-4191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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