Individual
TYLER LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2395 HYNES AVE N, SAINT PAUL, MN 55128-5128
(651) 746-9777
Mailing address
2395 HYNES AVE N, SAINT PAUL, MN 55128-5128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2483206
MN
Other
Enumeration date
09/04/2023
Last updated
05/01/2024
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