Provider Demographics
NPI:1942013859
Name:FRIEND, TYSHERIA (LPN)
Entity type:Individual
Prefix:
First Name:TYSHERIA
Middle Name:
Last Name:FRIEND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W. MARKET ST.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947
Mailing Address - Country:US
Mailing Address - Phone:302-778-9222
Mailing Address - Fax:302-403-8253
Practice Address - Street 1:501 W. MARKET ST.
Practice Address - Street 2:SUITE 105
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947
Practice Address - Country:US
Practice Address - Phone:302-778-9222
Practice Address - Fax:302-403-8253
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP56457164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse