Healthcare Provider Details

I. General information

NPI: 1780077628
Provider Name (Legal Business Name): TYLER GLUNT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAPLE HOLLOW RD
DUNCANSVILLE PA
16635-7920
US

IV. Provider business mailing address

PO BOX 574
DUNCANSVILLE PA
16635-0574
US

V. Phone/Fax

Practice location:
  • Phone: 814-693-2273
  • Fax: 814-693-1191
Mailing address:
  • Phone: 814-693-2273
  • Fax: 814-693-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN661105
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN661105
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN661105
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN661105
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: