Individual
MS. INGRID MARIA TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS FNP
Contact information
Practice address
780 2ND ST SE, BANDON, OR 97411-8354
(541) 347-2529
(541) 347-9196
Mailing address
130 PRINCIPE DE PAZ, SANTA FE, NM 87508-9211
(505) 780-5425
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP02197
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120353
MEDICARE GROUP PIN
OR
05
—
273956
—
OR
Enumeration date
05/19/2006
Last updated
03/07/2023
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