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General NPI Number Information
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NPI Number | 1760089585
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Entity Type | Individual
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Provider Name | TANYA MILLICENT KYLER FIELD MEDICAL MA
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Gender | Female
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 512 SHORB AVE NW APT 3
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City | CANTON
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State | OH
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Zip | 44703-2580
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Country | US
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Telephone | 234-410-4175
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20521
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City | CANTON
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State | OH
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Zip | 44701-0521
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Country | US
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Telephone | 234-410-4175
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E4UO-N515-GC9C
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License Number State | OH
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