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General NPI Number Information
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NPI Number | 1639696578
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Entity Type | Individual
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Provider Name | TYLER MORRIS POOL AUD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 2201 N BROADWELL AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-2153
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Country | US
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Telephone | 308-382-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 3026 WESTSIDE ST
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City | GRAND ISLAND
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State | NE
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Zip | 68803-2336
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Country | US
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Telephone | 308-390-4516
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 358
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License Number State | NE
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