Most Relevant Information
Provider Data
| NPI Number: | 1003534694 |
| Provider Name: | TYLER GRANT RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 688131 |
Most Important Dates
| Enumeration Date: | 08/18/2022 |
| Last Updated: | 12/19/2023 |
Provider Practice Location
301 PROSPECT AVE
SYRACUSE
NY
132031807
Practice Location Phone/Fax
| Phone: | 3154485111 |
| Fax: |
Provider Mailing Location
1305 WALT WHITMAN RD STE 300
MELVILLE
NY
117474300
Provider Mailing Phone/Fax
| Phone: | 5169453000 |
| Fax: |