Provider Demographics
NPI:1710763354
Name:WASYLISZYN, KAY T (DNP, AGNP-C, CNP, RN)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:T
Last Name:WASYLISZYN
Suffix:
Gender:F
Credentials:DNP, AGNP-C, CNP, RN
Other - Prefix:
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Mailing Address - Street 1:574 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1723
Mailing Address - Country:US
Mailing Address - Phone:651-253-4792
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE STE 220
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2866
Practice Address - Country:US
Practice Address - Phone:763-786-1620
Practice Address - Fax:763-780-3099
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10702363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology