Provider Demographics
NPI:1760099337
Name:PISAREVSKAYA, TATYANA (FNP)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:PISAREVSKAYA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2755
Mailing Address - Country:US
Mailing Address - Phone:847-441-5020
Mailing Address - Fax:
Practice Address - Street 1:181 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2755
Practice Address - Country:US
Practice Address - Phone:847-441-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily