Individual
TYRUS HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
P O 0698, PASADENA, CA 91110-0698
(602) 263-1200
(602) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN131136
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00
—
AZ
Enumeration date
08/24/2016
Last updated
08/24/2016
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