Healthcare Provider Details

I. General information

NPI: 1548214133
Provider Name (Legal Business Name): LORRIE W HYLKEMA RN, CS, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N BROOKS ST VA CSP
MADISON WI
53715-1002
US

IV. Provider business mailing address

438 TOEPFER AVE
MADISON WI
53711-1660
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-7195
  • Fax: 608-256-0743
Mailing address:
  • Phone: 608-233-7103
  • Fax: 608-233-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1857-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: