Healthcare Provider Details

I. General information

NPI: 1124684568
Provider Name (Legal Business Name): TATYANA IVANOVNA VASILISHIN DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

IV. Provider business mailing address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

V. Phone/Fax

Practice location:
  • Phone: 206-835-7400
  • Fax: 206-835-7439
Mailing address:
  • Phone: 206-835-7400
  • Fax: 206-835-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61075003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: