Doctor Name: | TYRON WENTWORTH |
NPI Number: | 1003127150 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.N. |
License Number: | 4704196552 |
Business Practice Address: | 200 Orleans Blvd Coldwater, MI - 490361767 |
Business Phone Number: | 5172782129 |
Business Fax Number: | 5172798172 |
Mailing Address: | 200 Orleans Blvd, COLDWATER |
State: | MI |
Postal Code: | 490361767 |
Phone Number: | 5172782129 |
Fax Number: | 5172798172 |
NPI Enumeration Date: | 06/23/2010 |
NPI Last Update Date: | 06/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | 4704196552 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |