Provider Demographics
NPI:1346458064
Name:LYNGAAS, JESSICA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEAN
Last Name:LYNGAAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24026 COUNTY HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537
Mailing Address - Country:US
Mailing Address - Phone:218-998-4207
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0558701164W00000X
NDL10376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse