=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043241730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN TAYLOR MACLEAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 02/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 S BOUNDARY AVE
-----------------------------------------------------
City | PROCTOR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55810-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-624-4819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-786-8364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34534
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------