Individual
DANIELLE TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2045 EASTGATE DR STE B, GREENVILLE, NC 27858-4153
(252) 864-8287
Mailing address
2045 EASTGATE DR STE B, GREENVILLE, NC 27858-4153
(252) 864-8287
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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