MEDICARE: TONYA MIAL MSN

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
1	163WP2201X	Ambulatory Care Registered Nurse	137152	NC

General Provider Information

NPI Number	:	1417505249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA MIAL MSN

Provider Business Mailing Address
First Line	:	3313 EDWARDS CT
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6248
Country	:	US
Telephone Number	:	208-447-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 MOYE BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2885
Country	:	US
Telephone Number	:	252-830-2149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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