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General NPI Number Information
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NPI Number | 1639597727
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Entity Type | Individual
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Provider Name | BRENT TYLER CNIM
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Gender | Male
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 2733 DOREEN CT
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City | FAIRBANKS
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State | AK
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Zip | 99709-2424
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Country | US
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Telephone | 281-324-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 2733 DOREEN CT
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City | FAIRBANKS
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State | AK
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Zip | 99709-2424
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Country | US
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Telephone | 281-324-5660
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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