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Individual
TYLER DWANE MANSBERGER
Active
Individual
TYLER DWANE MANSBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA056247
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008434780002
—
PA
05
—
102926115-0002
—
PA
05
—
102926115-0003
—
PA
05
—
102926115-0004
—
PA
05
—
102926115-0005
—
PA
05
—
102926115-0006
—
PA
05
—
102926115-0007
—
PA
05
—
102926115-0008
—
PA
05
—
102926115-0009
—
PA
01
—
400472
HUMANA
PA
01
—
709708
AMERIHEALTH CARITAS
PA
01
—
754008
PART-B PTAN
PA
Enumeration date
10/22/2013
Last updated
08/31/2022
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