Provider Demographics
NPI:1073999157
Name:CWIKLA, LYNDSEY (PA)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:CWIKLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:925-215-4540
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:SUITE 205C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-221-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant