Provider Demographics
NPI:1477535490
Name:PHILLIPPE, LYNN CAROL (NP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:CAROL
Last Name:PHILLIPPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:CAROL
Other - Last Name:WIRSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11563 E 1150TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-4352
Mailing Address - Country:US
Mailing Address - Phone:618-544-5405
Mailing Address - Fax:
Practice Address - Street 1:1001 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1945
Practice Address - Country:US
Practice Address - Phone:618-263-4970
Practice Address - Fax:618-263-4837
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S96816Medicare UPIN