Provider Demographics
NPI:1053157966
Name:DETMERS, TYTUS XAVIER
Entity type:Individual
Prefix:
First Name:TYTUS
Middle Name:XAVIER
Last Name:DETMERS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 TRENT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4537
Mailing Address - Country:US
Mailing Address - Phone:252-631-5337
Mailing Address - Fax:252-631-5342
Practice Address - Street 1:1917 TRENT BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4537
Practice Address - Country:US
Practice Address - Phone:252-631-5337
Practice Address - Fax:252-631-5342
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other