Provider Demographics
NPI:1447271804
Name:TYLER, STEFANIE NELSON (WHNP-BC)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:NELSON
Last Name:TYLER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:D
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP, MSN
Mailing Address - Street 1:105 VINEYARD WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8849
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:610-444-4656
Practice Address - Street 1:105 VINEYARD WAY STE 200
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8849
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:610-444-4656
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686455363LW0102X
NY420789363LW0102X
PASP019735363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health