Provider Demographics
NPI:1124684568
Name:VASILISHIN, TATYANA IVANOVNA (DNP, ARNP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:IVANOVNA
Last Name:VASILISHIN
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 260
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-835-7400
Mailing Address - Fax:206-835-7439
Practice Address - Street 1:16233 SYLVESTER RD SW STE 260
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-835-7400
Practice Address - Fax:206-835-7439
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61075003363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2167972Medicaid