Provider Demographics
NPI:1457315970
Name:NYQUIST, LYNN M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:NYQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:BERGSTRAESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 15TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3821
Mailing Address - Country:US
Mailing Address - Phone:701-774-7470
Mailing Address - Fax:701-774-7479
Practice Address - Street 1:1301 15TH AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3821
Practice Address - Country:US
Practice Address - Phone:701-774-7470
Practice Address - Fax:701-774-7479
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225698-1207Q00000X
ND14250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339742Medicaid
ND1468995Medicaid
NYH11543Medicare UPIN