Provider Demographics
NPI:1265447999
Name:KREBS, LYNNE M (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:KREBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:HAWLEY-KREBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:866-313-0337
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:661 S SILVERBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3863
Practice Address - Country:US
Practice Address - Phone:262-335-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54345-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43304500Medicaid
R40674Medicare UPIN
WI0001 21215Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #