Provider Demographics
NPI:1952373102
Name:WHYTE KASMARIK, TAMARA LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:WHYTE KASMARIK
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 1:17705 HUTCHINS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4102
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:
Practice Address - Street 1:17705 HUTCHINS DR STE 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4102
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0999234363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046G4KAOtherBCBS
MNCP9041014218OtherPREFERRED ONE
MN1202588OtherMEDICA
MN1202588OtherMEDICA