Provider Demographics
NPI:1477753713
Name:HAYNIE, LYNDSEY SUSANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:SUSANNE
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8304
Mailing Address - Country:US
Mailing Address - Phone:970-927-1757
Mailing Address - Fax:970-927-8633
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1780
Practice Address - Country:US
Practice Address - Phone:970-925-4141
Practice Address - Fax:970-925-4233
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA-2447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant