Basic Information
| Provider Information | |||||||||
| NPI: | 1053740761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RINGENOLDUS | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BERGLUND | ||||||||
| OtherFirstName: | LYNN | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 GROVE AVE | ||||||||
| Address2: | P.O. BOX 314 | ||||||||
| City: | WILD ROSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549846901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206225560 | ||||||||
| FaxNumber: | 9206226021 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | WILD ROSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549846901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206225560 | ||||||||
| FaxNumber: | 9206226021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2013 | ||||||||
| LastUpdateDate: | 11/03/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5510-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.