Healthcare Provider Details

I. General information

NPI: 1356077796
Provider Name (Legal Business Name): TYSEN CHANE MCDOWELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N SAINT JOSEPH AVE STE 106
HASTINGS NE
68901-4422
US

IV. Provider business mailing address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4497
US

V. Phone/Fax

Practice location:
  • Phone: 402-462-2139
  • Fax:
Mailing address:
  • Phone: 402-463-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3068
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: