Provider Demographics
NPI:1124044516
Name:STEEN, LYNETTE O (CNP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:O
Last Name:STEEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 KANSAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4057
Mailing Address - Country:US
Mailing Address - Phone:605-554-0118
Mailing Address - Fax:605-352-8704
Practice Address - Street 1:111 4TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2509
Practice Address - Country:US
Practice Address - Phone:605-352-8691
Practice Address - Fax:605-352-8704
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6827892Medicaid
SD103387OtherMEDICARE ID UNSPECIFIED