Basic Information
| Provider Information | |||||||||
| NPI: | 1568545960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESOTEL | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | JANINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WITTHOPF | ||||||||
| OtherFirstName: | LYNNE | ||||||||
| OtherMiddleName: | JANINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 312 EAST MAIN | ||||||||
| Address2: | MCFARLAND CLINIC PC | ||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501580000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417525469 | ||||||||
| FaxNumber: | 6418442205 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 EAST MAIN | ||||||||
| Address2: | MCFARLAND CLINIC PC | ||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501580000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417525469 | ||||||||
| FaxNumber: | 6418442205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48790-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 37123 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.