Healthcare Provider Details
I. General information
NPI: 1285268284
Provider Name (Legal Business Name): LYNDSIE LUJAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/27/2020
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2710 SAINT FRANCIS DR STE 320
WATERLOO IA
50702-5620
US
IV. Provider business mailing address
1604 OLIVE ST
CEDAR FALLS IA
50613-3716
US
V. Phone/Fax
- Phone: 319-272-5000
- Fax: 319-272-8072
- Phone: 515-447-8199
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | 110016 |
| License Number State | IA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: