Individual
TYLER LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 WATER LILY LN NE APT B, WASHINGTON, DC 20019-1913
(919) 298-0291
Mailing address
770 WATER LILY LN NE APT B, WASHINGTON, DC 20019-1913
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070981647
—
DC
Enumeration date
02/01/2021
Last updated
02/01/2021
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