Healthcare Provider Details

I. General information

NPI: 1053740761
Provider Name (Legal Business Name): LYNN ANNETTE RINGENOLDUS APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN A BERGLUND

II. Dates (important events)

Enumeration Date: 11/03/2013
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MEMORIAL DR STE 300
BERLIN WI
54923-1241
US

IV. Provider business mailing address

191 MEMORIAL DR STE 300
BERLIN WI
54923-1241
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-5717
  • Fax: 920-361-6361
Mailing address:
  • Phone: 920-361-5717
  • Fax: 920-361-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5510-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: