Provider Demographics
NPI:1407022866
Name:SCHWERSINSKE, LYNN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:SCHWERSINSKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 OLD GATE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7202
Mailing Address - Country:US
Mailing Address - Phone:608-244-4750
Mailing Address - Fax:
Practice Address - Street 1:3113 OLD GATE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7202
Practice Address - Country:US
Practice Address - Phone:608-244-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134566-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38240500Medicaid