Individual
KAY L TYBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-4105
(612) 904-4644
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-4105
(612) 904-4644
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2006001671
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025N3TY
BLUE CROSS BLUE SHIELD
MN
01
—
04-08776
MEDICA
MN
05
—
575324400
—
MN
Enumeration date
05/31/2006
Last updated
11/02/2012
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