Provider Demographics
NPI:1245384239
Name:SWEDBERG, LYNETTE R (RN, MS, CNS)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:R
Last Name:SWEDBERG
Suffix:
Gender:F
Credentials:RN, MS, CNS
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:R
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 FOXPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3221
Mailing Address - Country:US
Mailing Address - Phone:815-748-8334
Mailing Address - Fax:
Practice Address - Street 1:760 FOXPOINTE DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3221
Practice Address - Country:US
Practice Address - Phone:815-748-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.004182364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209004182Medicaid
IL104030OtherHEALTH ALLIANCE
ILQ01622Medicare UPIN