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General NPI Number Information
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NPI Number | 1720213812
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Entity Type | Individual
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Provider Name | EDUARD TSYRULNYKOV APNP
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 11649 N PORT WASHINGTON RD STE 201&221
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City | MEQUON
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State | WI
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Zip | 53092-3460
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Country | US
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Telephone | 262-999-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone | 262-999-3495
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9921-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200181
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11016687
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95019975
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License Number State | CA
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