Healthcare Provider Details

I. General information

NPI: 1891673554
Provider Name (Legal Business Name): TRAVIS JOHN LAMECKER CNP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW
WILLMAR MN
56201-3556
US

IV. Provider business mailing address

1224 29TH ST NW
WILLMAR MN
56201-2052
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax:
Mailing address:
  • Phone: 320-314-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: