Provider Demographics
NPI:1326234469
Name:PALACHECK, LYN MARIE (CNS)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:MARIE
Last Name:PALACHECK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24750 FIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-7214
Mailing Address - Country:US
Mailing Address - Phone:651-261-5360
Mailing Address - Fax:651-464-4845
Practice Address - Street 1:24750 FIELD AVE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-7214
Practice Address - Country:US
Practice Address - Phone:651-261-5360
Practice Address - Fax:651-464-4845
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR082801-7364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health