Provider Demographics
NPI:1275524175
Name:VALENTIJN, LYNNETTE M (MD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:M
Last Name:VALENTIJN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CRANBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5216
Mailing Address - Country:US
Mailing Address - Phone:715-393-3900
Mailing Address - Fax:
Practice Address - Street 1:3301 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5216
Practice Address - Country:US
Practice Address - Phone:715-393-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000869274OtherBCBS BMG PEDIATRICS BRISTOL ST
IN100260460Medicaid
IN000000869274OtherBCBS BMG PEDIATRICS BRISTOL ST