Individual
TYLER WILLIAM RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1338 PHAY AVE, CANON CITY, CO 81212-2311
(719) 285-2000
Mailing address
PO BOX 911057, DENVER, CO 80291-1057
(800) 953-0104
(303) 765-6640
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP61177225
WA
363LF0000X
Family Nurse Practitioner
AP61177225
WA
363LF0000X
Family Nurse Practitioner
Primary
APN.0994692-NP
CO
Other
Enumeration date
05/24/2019
Last updated
06/19/2024
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