Healthcare Provider Details

I. General information

NPI: 1689480774
Provider Name (Legal Business Name): LYNDSIE PUFFETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

IV. Provider business mailing address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

V. Phone/Fax

Practice location:
  • Phone: 319-481-6349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141091
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: