MEDICARE: LYNDA CARR

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	164W00000X	Licensed Practical Nurse	34398-31	WI

General Provider Information

NPI Number	:	1184498214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA CARR

Provider Business Mailing Address
First Line	:	5240 BISHOPS BAY PKWY
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 BISHOPS BAY PKWY
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8820
Country	:	US
Telephone Number	:	608-434-0492
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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Directions to “ LYNDA CARR ” Practice Location

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