MEDICARE: ELEANOR RENEE TYE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1053998484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR RENEE TYE

Provider Business Mailing Address
First Line	:	1280 EAST 168 ST
Second Line	:	DOWN
City	:	CLEVELAND
State	:	OH
Zip	:	44110
Country	:	US
Telephone Number	:	216-882-4650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 EAST 168 ST
Second Line	:	DOWN
City	:	CLEVELAND
State	:	OH
Zip	:	44110-4411
Country	:	US
Telephone Number	:	216-315-2072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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Directions to “ ELEANOR RENEE TYE ” Practice Location

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