Basic Information
| Provider Information | |||||||||
| NPI: | 1336375211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINCLAIR | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KUENNEN | ||||||||
| OtherFirstName: | LORI | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3421 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192728000 | ||||||||
| FaxNumber: | 3192728850 | ||||||||
| Practice Location | |||||||||
| Address1: | 3421 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192728000 | ||||||||
| FaxNumber: | 3192728850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 40779 | IA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0102X | R-8681 | IA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 40779 | IA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 203758 | 01 | IA | UCARE | OTHER | 1336375211 | 05 | MN | MEDICAID |