MEDICARE: INDIRA TYLER

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	163W00000X	Registered Nurse	205160	NC

General Provider Information

NPI Number	:	1538353404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIRA TYLER

Provider Business Mailing Address
First Line	:	1200 MURCHISON RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-4252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 MURCHISON RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-4252
Country	:	US
Telephone Number	:	910-672-1930
Fax Number	:

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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