Provider Demographics
NPI:1235719311
Name:WYTTENBACK, LINDSEY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JEAN
Last Name:WYTTENBACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:JEAN
Other - Last Name:SCRIBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:40519 FENIAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056
Mailing Address - Country:US
Mailing Address - Phone:612-223-3973
Mailing Address - Fax:
Practice Address - Street 1:40519 FENIAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056
Practice Address - Country:US
Practice Address - Phone:612-223-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2439527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse