MEDICARE: MONEEKE TYLER RN

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	163W00000X	Registered Nurse	460762	OH

General Provider Information

NPI Number	:	1629374392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONEEKE TYLER RN

Provider Business Mailing Address
First Line	:	2137 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	216-451-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2137 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	216-926-6694
Fax Number	:

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

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	02/12/2026

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