Provider Demographics
NPI:1568856631
Name:MISHKIN GLEYZER, TATYANA (CNP)
Entity Type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:
Last Name:MISHKIN GLEYZER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ENERGY PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5274
Mailing Address - Country:US
Mailing Address - Phone:651-361-7278
Mailing Address - Fax:651-523-7139
Practice Address - Street 1:1010 WEST SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-496-4467
Practice Address - Fax:952-496-4911
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP1776363L00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology