Individual
JENNIFER TYSOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
872 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5927
(505) 867-2383
(505) 867-7293
Mailing address
12400 SKYLINE RD NE # 115, ALBUQUERQUE, NM 87123-3020
(505) 867-2383
(505) 867-7293
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/25/2008
Last updated
05/02/2008
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