Healthcare Provider Details

I. General information

NPI: 1871317859
Provider Name (Legal Business Name): TYLER SAMUEL SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 NOLL AVE
PITTSBURGH PA
15205-2110
US

IV. Provider business mailing address

192 NOLL AVE
PITTSBURGH PA
15205-2110
US

V. Phone/Fax

Practice location:
  • Phone: 412-863-3551
  • Fax:
Mailing address:
  • Phone: 412-863-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN739808
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: