IndividualActive
Mary Tyler
NPI 1821132036 · Neonatal Nurse Practitioner · St Louis Park, MN
Provider details
- NPI number
- 1821132036
- Entity type
- Individual
- Primary specialty
- Neonatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- No
- License
- R 078430-0 (MN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone: (952) 993-5000
Approximate (ZIP-level) locationGet directions
Mailing address
6465 Wayzata Blvd
Minneapolis, MN 55426-1728
Registry dates
- Enumerated
- 2007-02-19
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.