| Doctor Name: | KATHY TYSDAL |
| NPI Number: | 1811943533 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSHYCHATRIC RNC |
| License Number: | R1566585 |
| Business Practice Address: | 40520 Co Hwy 34 White Earth Health Center Ogema, MN - 56569 |
| Business Phone Number: | 2189834300 |
| Business Fax Number: | 2189836217 |
| Mailing Address: | 24746 Co Hwy 1, FERGUS FALLS |
| State: | MN |
| Postal Code: | 56537 |
| Phone Number: | 2187392753 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | R1566585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |