Provider Demographics
NPI:1336385038
Name:TYNE, VICKY JEAN
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:JEAN
Last Name:TYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S AMMONS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1330
Mailing Address - Country:US
Mailing Address - Phone:303-231-9811
Mailing Address - Fax:
Practice Address - Street 1:65 S AMMONS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1330
Practice Address - Country:US
Practice Address - Phone:303-231-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84185163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care