Healthcare Provider Details

I. General information

NPI: 1891091468
Provider Name (Legal Business Name): RONALD LEE TYSON RN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 3014
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 3014
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-4788
  • Fax: 513-636-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA11915NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: