Provider Demographics
NPI:1467480061
Name:SPINDLER- EBENSPERGER, LYNN THERESE (PA-C MMS)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:THERESE
Last Name:SPINDLER- EBENSPERGER
Suffix:
Gender:F
Credentials:PA-C MMS
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:THERESE
Other - Last Name:SPINDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:815 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PEPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54759-9662
Mailing Address - Country:US
Mailing Address - Phone:715-495-6385
Mailing Address - Fax:
Practice Address - Street 1:16490 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4300
Practice Address - Country:US
Practice Address - Phone:715-495-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1110-023363A00000X
MN12507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42979600Medicaid
WI42979600Medicaid
WI009400467Medicare ID - Type Unspecified