Provider Demographics
NPI:1104510247
Name:VYSHUTINA, MARINA OLEGOVNA (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:OLEGOVNA
Last Name:VYSHUTINA
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Gender:F
Credentials:APRN-CNP
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Mailing Address - Street 1:1155 MILL ST # MSM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3900
Practice Address - Street 1:1500 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-2410
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV868219363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology