| NPI | 1821023409 |
|---|---|
| Former Name | LUCILLE R TYLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 23834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5304) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-05-20 |