Provider Demographics
NPI:1144748351
Name:WYLIN, KASANDRA LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:LEE
Last Name:WYLIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69111 N. FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062
Mailing Address - Country:US
Mailing Address - Phone:586-625-2798
Mailing Address - Fax:
Practice Address - Street 1:69111 N FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1521
Practice Address - Country:US
Practice Address - Phone:586-625-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily