Individual
TYRA REAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1153 STACY DR, CANTON, MI 48188-1426
(717) 801-6030
Mailing address
1153 STACY DR, CANTON, MI 48188-1426
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703130901
MI
Other
Enumeration date
01/22/2026
Last updated
01/22/2026
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