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Individual

TYLER ALLEN REX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(754) 647-1000
Mailing address
17875 BELLOWS FALLS DR N, SOUTH BEND, IN 46614-9721

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
28216557C
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28216557C
IN

Other

Enumeration date
02/09/2024
Last updated
05/29/2024
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