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NPI Code Detail

MEDICARE: LYNNE M DEREZINSKI APNP

MEDICARE: LYNNE M DEREZINSKI APNP
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
1363L00000XNurse Practitioner4200WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14200OTHERWIWI STATE LIC

General Provider Information

NPI Number : 1205146222
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNE M DEREZINSKI APNP
Provider Business Mailing Address
First Line : 5412 US HIGHWAY 10 E
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8559
Country : US
Telephone Number : 715-346-5243
Fax Number :
Provider Business Practice Location Address
First Line : 5412 US HIGHWAY 10 E
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8559
Country : US
Telephone Number : 715-346-5243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2010
Last Update Date : 10/08/2010

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Directions to “ LYNNE M DEREZINSKI APNP” Practice Location

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