Healthcare Provider Details

I. General information

NPI: 1083698518
Provider Name (Legal Business Name): MICHELLE TYSER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 800
LINCOLN NE
68506-1200
US

IV. Provider business mailing address

1500 S 48TH ST STE 800
LINCOLN NE
68506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8600
  • Fax: 402-483-8689
Mailing address:
  • Phone: 402-483-8600
  • Fax: 402-483-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1215
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1215
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: