Healthcare Provider Details

I. General information

NPI: 1740793280
Provider Name (Legal Business Name): DAWN RENEE TYLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S EXETER ST
BALTIMORE MD
21202-4316
US

IV. Provider business mailing address

630 S EXETER ST
BALTIMORE MD
21202-4316
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-6520
  • Fax: 410-962-5050
Mailing address:
  • Phone: 410-962-6520
  • Fax: 410-962-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR207960
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR207960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: