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General NPI Number Information
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NPI Number | 1184462061
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Entity Type | Individual
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Provider Name | SHRIYANI TAYLOR TYSEN NP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2024
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 621 MEMORIAL DR STE 612
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City | SOUTH BEND
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State | IN
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Zip | 46601-1085
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Country | US
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Telephone | 574-232-3325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 778912
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City | CHICAGO
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State | IL
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Zip | 60677-8912
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Country | US
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Telephone | 317-777-6435
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Fax | 317-777-6644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 71015594A
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License Number State | IN
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