=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477354231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LASHAWNNA TYLER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2025
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2081 BRONZE STAR DR
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95776-5423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-668-2600
-----------------------------------------------------
Fax | 530-661-1027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3294 OWL CT
-----------------------------------------------------
City | WEST SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95691-6453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-320-7238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95032203
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------