Healthcare Provider Details

I. General information

NPI: 1861134603
Provider Name (Legal Business Name): LYNETTE ANN ZUIDEMA HAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 OSLOSKI RD
EUREKA MT
59917-9217
US

IV. Provider business mailing address

4395 US HIGHWAY 93 W UNIT 2
WHITEFISH MT
59937-1759
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-3145
  • Fax:
Mailing address:
  • Phone: 541-645-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number132307
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: