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NPI Code Detail

MEDICARE: LYNDA LAUER PENCE DNP, AGPCNP-BC

MEDICARE: LYNDA LAUER PENCE DNP, AGPCNP-BC
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 Practitioner4704269925MI
2163W00000XRegistered Nurse4704269925MI

General Provider Information

NPI Number : 1942721519
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA LAUER PENCE DNP, AGPCNP-BC
Provider Business Mailing Address
First Line : 5758 COOLEY LAKE RD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-3073
Country : US
Telephone Number : 855-466-3631
Fax Number :
Provider Business Practice Location Address
First Line : 5758 COOLEY LAKE RD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-3073
Country : US
Telephone Number : 855-466-3631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2017
Last Update Date : 10/04/2022

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