Healthcare Provider Details

I. General information

NPI: 1073597761
Provider Name (Legal Business Name): LYNDSEY S MAVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

IV. Provider business mailing address

2105 E ENTERPRISE AVE
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 920-560-1000
  • Fax: 920-731-6732
Mailing address:
  • Phone: 920-560-1000
  • Fax: 920-731-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4409-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number765
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: