Provider Demographics
NPI:1215467139
Name:MCGLYNN, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MCGLYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44199 410TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LENGBY
Mailing Address - State:MN
Mailing Address - Zip Code:56651-4030
Mailing Address - Country:US
Mailing Address - Phone:218-280-1609
Mailing Address - Fax:
Practice Address - Street 1:117 2ND ST NE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1301
Practice Address - Country:US
Practice Address - Phone:218-435-1044
Practice Address - Fax:218-435-1143
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213700-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse