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NPI Code Detail

MEDICARE: TYRAHN DENNIS

MEDICARE: TYRAHN DENNIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN292400PA

General Provider Information

NPI Number : 1386062966
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRAHN DENNIS
Provider Business Mailing Address
First Line : 7248 ELMWOOD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19142-1533
Country : US
Telephone Number : 215-531-4178
Fax Number :
Provider Business Practice Location Address
First Line : 7248 ELMWOOD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19142-1533
Country : US
Telephone Number : 215-531-4178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 04/01/2014

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Directions to “ TYRAHN DENNIS ” Practice Location

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