MEDICARE: MRS. LORRIE W HYLKEMA RN, CS, APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	1857-033	WI

General Provider Information

NPI Number	:	1548214133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORRIE W HYLKEMA RN, CS, APNP

Provider Business Mailing Address
First Line	:	438 TOEPFER AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-1660
Country	:	US
Telephone Number	:	608-233-7103
Fax Number	:	608-233-7103

Provider Business Practice Location Address
First Line	:	306 N BROOKS ST
Second Line	:	VA CSP
City	:	MADISON
State	:	WI
Zip	:	53715-1002
Country	:	US
Telephone Number	:	608-280-7195
Fax Number	:	608-256-0743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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