Healthcare Provider Details

I. General information

NPI: 1770328528
Provider Name (Legal Business Name): LYNSEY BROUILLETTE DNP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S MUCKEY ST
MAPLETON IA
51034-1055
US

IV. Provider business mailing address

803 MAIN ST
MAPLETON IA
51034-1325
US

V. Phone/Fax

Practice location:
  • Phone: 712-882-2234
  • Fax:
Mailing address:
  • Phone: 712-880-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA179930
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: