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General NPI Number Information
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NPI Number | 1316731458
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Entity Type | Individual
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Provider Name | TYLER MICHAEL FENTON
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Gender | Male
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Dates
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Enumeration Date | 04/05/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1506 MENTOR AVE
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City | PAINESVILLE
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State | OH
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Zip | 44077-1705
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Country | US
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Telephone | 440-354-5609
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Fax |
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Provider Business Mailing Address
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Address Line | 37406 PARK AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-6051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0038773
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License Number State | OH
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