Healthcare Provider Details

I. General information

NPI: 1558297291
Provider Name (Legal Business Name): LYNZI STAUDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 FERRY ST
LA CROSSE WI
54601-4717
US

IV. Provider business mailing address

307 MALLARD DR
HOLMEN WI
54636-9796
US

V. Phone/Fax

Practice location:
  • Phone: 608-519-4620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number850023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: