Provider Demographics
NPI:1073393898
Name:GRAFF, LYNDI KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNDI
Middle Name:KAY
Last Name:GRAFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LYNDI
Other - Middle Name:KAY
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 W FLORIDA ST APT 410
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1567
Mailing Address - Country:US
Mailing Address - Phone:715-816-4475
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE DR STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-298-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7636363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical