Provider Demographics
NPI:1154128726
Name:ZACH, TYLER JOSEPH
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:ZACH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W BENTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-4124
Mailing Address - Country:US
Mailing Address - Phone:402-360-1949
Mailing Address - Fax:
Practice Address - Street 1:605 W BENTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-4124
Practice Address - Country:US
Practice Address - Phone:402-360-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant