MEDICARE: LYNDSAY BUTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28174844A	IN

General Provider Information

NPI Number	:	1134714116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDSAY BUTT

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8028 CARNEGIE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5787
Country	:	US
Telephone Number	:	260-425-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	10/14/2022

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Directions to “ LYNDSAY BUTT ” Practice Location

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