Provider Demographics
NPI:1770937781
Name:VELISHEK, TANYA LYNN (MSN, RN, PHN, PNP-PC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:VELISHEK
Suffix:
Gender:F
Credentials:MSN, RN, PHN, PNP-PC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:845 HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1858
Mailing Address - Country:US
Mailing Address - Phone:612-275-4416
Mailing Address - Fax:
Practice Address - Street 1:2535 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3205
Practice Address - Country:US
Practice Address - Phone:612-672-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4496363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics